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J Am Geriatr Soc. 1992 Apr;40(4):381-5.

Reducing and managing restraints in long-term-care facilities.

Author information

  • 1UCLA School of Medicine.

Abstract

OBJECTIVE:

To evaluate a management system designed to improve staff adherence to a federal regulation that stated restrained residents should be released, exercised, and repositioned every 2 hours.

DESIGN:

A delayed intervention, controlled, cross-over design with three phases. During phase one, baseline, the length of intervals that residents remained in restraints was monitored. The intervention was implemented at site A in Phase two while site B remained in baseline. During Phase three, the intervention was replicated at site B.

SETTING:

Two long-term care proprietary nursing facilities.

PATIENTS:

Sixty-three physically restrained residents in the two facilities.

INTERVENTION:

The intervention was a system of restraint release using colored pads corresponding to specific hours. The management rule was that the resident should be on a different colored pad every 2 hours. Staff had to lift residents to place the pad, and the colors made the system easy for supervisors to check.

MAIN OUTCOME MEASURES:

Checks by research personnel by black light and invisible ink, to detect movement of the knot tying the restraints.

RESULTS:

During the baseline phase, the majority of residents at both sites were inappropriately restrained longer than 2 hours (site A: 54.1%; site B: 60.1%). The percentage of residents restrained over 2 hours was significantly reduced during the intervention phase to 13.9% (site A) and 19.4% (site B). Three weeks after the end of the intervention, inappropriate use of restraints remained low, 14.2%, but rose to 47.7% after another 3 weeks.

CONCLUSION:

The management system is an effective way to increase the consistency with which nursing-home staff release and reposition restrained residents.

PMID:
1556366
[PubMed - indexed for MEDLINE]
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