Alternatives to physical and pharmacologic restraints in long-term care.

The most effective programs for reducing the use of restraints involve facility policy initiatives that are strongly supported by the medical director, the administrator and the director of nursing. The physician and nursing home staff must recognize that physical and pharmacologic restraints have different purposes. Implementing alternatives to restraints requires a careful examination of the source of the problem behavior and an individualized approach. Alternatives to medication should be stressed. When a medication is necessary, it should be prescribed for a limited time, with a definite date for discontinuation. Family physicians can actively participate in restraint reduction programs, whether by initiating the process or by providing support and counseling to staff.