Avoiding physical restraints in long-term care facilities
| Publication Type | | Caremap |
| Year of Publication | | 2003 |
| Authors | | Dimant, J. |
| Journal | | Journal of the American Medical Directors Association |
| Volume | | 4 |
| Number | | 4 |
| Pagination | | 207-215 |
| Type of Work | | Journal Article |
| Topic | | Restraint |
| Abstract | | Within nursing homes, the prevention of falls and related injuries is a significant clinical challenge. Physical restraint use has been demonstrated to be ineffective in preventing falls and injuries in nursing home residents. Additionally, several regulations (in the United States) place limits on restraint use. Despite these factors, restraint use is still relatively common within long-term care settings. This article outlines recommendations for the development of individualized care plans that avoid restraint use. The care plan process complies with the Joint Commission on Accreditation of Healthcare Organizations standards on the use of restraints in long-term care settings. The guidelines aim to assist long-term care providers to eliminate inappropriate restraint use, safely implement appropriate restraint use, and implement alternatives to restraint use. The guideline development team members and process are not outlined. The article includes citations to published evidence, however there is no discussion of how this evidence was evaluated or how the recommendations were developed. The definition of restraints and the Joint Commission on Accreditation of Healthcare Organizations standards on the use of restraints in long-term care are discussed. The recommended care plan development process is outlined. The steps include assessment, care planning, management, and quality assurance and improvement. Assessment involves identifying medical symptoms that may warrant restraint use and evaluating the cause(s) of these symptoms. Care planning should involve an interdisciplinary team and the resident and/or a surrogate. The wishes of the resident and/or surrogate must be considered. The plan should focus on removing the cause(s) of the symptoms that warrant restraint use and the article discusses potential strategies for addressing common causes of these symptoms. Planning also involves identifying potential adverse outcomes of restraint use. Management involves obtaining a physician’s order for restraint use, applying restraints correctly, and monitoring for adverse outcomes. The outcomes of the care plan should be evaluated on a continual basis, allowing for changes in the plan to be made. Quality assurance and improvement strategies include monitoring trends in restraint use (such as number and type of restraints, and adverse outcomes) and implementing strategies to decrease their use. |
| Cluzeau rating | | 13 |
| Evidence rating | | 1 |
| Inter-rater reliability | | 0.9 |
| Combined score | | 30 |
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