MODELS OF GERIATRIC PRACTICE: Progress Toward a Restraint‐Free Environment in a Large Academic Nursing Facility

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Abstract
To review the implementation and evolution of a successful physical restraint reduction program in a large nursing facility. An initiative to reduce physical restraint began in March of 1990 with formation of a Restraint Review Committee (RRC), which developed and guided a program of inservice education, policy change, and procedural innovation. Progress was measured by monthly prevalence surveys of restraint use, both unit-specific and facility-wide. The study took place in an 816-bed not-for-profit nursing facility with academic affiliation and closed medical staff. Mean age of residents was 85.5; 74% were female and 26% male. Physical restraint prevalence in our facility was reduced from 39% to 4% over 3 years, with marked decrease in variation among nursing units. Prevalence initially decreased to 20% after policy modifications and inservice education programs. Further innovations in procedure and policy resulted in continued reduction of physical restraint to 4%. The facility-wide rate of falls and accident-related injuries did not change over the 3-year period. Decrease in physical restraint was not accompanied by a change in the percentage of residents prescribed psychotropic medications such as benzodiazepines and neuroleptics. In response to the mandate to provide a least-restrictive environment, our institution has developed a successful system resulting in a dramatic reduction in physical restraint use. Changes in institutional culture and barriers to change are discussed, as well as issues of cost and generalizability.

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