OBJECTIVES: To describe how removing physical restraints affected injuries
in nursing home settings.
DESIGN: A 2-year prospective study of an educational intervention for physi
cal restraint reduction.
SETTING: Sixteen diverse nursing homes with 2075 beds in California, Michig
an, New York, and North Carolina.
PARTICIPANTS: Study A: 859 residents who were physically restrained at the
onset of the intervention on October 1, 1991. Study B: all residents who oc
cupied the 2075 beds in the 16 facilities 3 months before the intervention
and 3 months after its completion.
INTERVENTION: Educational program for nursing home staff followed by quarte
rly site consultations to participating nursing homes.
MAIN OUTCOME MEASURES: Rate of physical restraint use and injuries.
RESULTS: Study A: Serious injuries declined significantly among the 859 res
idents restrained initially when restraint orders were discontinued (chi(2)
= 6.2, P = .013). Study B: During the intervention period, physical restra
int use among the 2075 residents decreased from 41% to 4%, a 90% reduction.
The decrease in the percentage of injuries of moderate to serious severity
was significant (i.e., 7.5% vs 4.4%, P2-tail = .0004) as was the rate of m
oderate and serious injuries combined (Rate Ratio = 1.580, P2-tail = .0033)
.
CONCLUSIONS: A substantial decrease in restraint use occurred without an in
crease in serious injuries. Although minor injuries and falls increased, re
straint-free care is safe when a comprehensive assessment is done and restr
aint alternatives are used.