A CLINICAL-TRIAL TO REDUCE RESTRAINTS IN NURSING-HOMES

OBJECTIVE: To investigate the relative effects of two experimental int erventions on the use of physical restraints. DESIGN: Prospective 12-m onth clinical trial in which three nursing homes were randomly assigne d to restraint education (RE), restraint education-with-consultation ( REC), or control (C). SETTING: Three voluntary nursing homes in the Ph iladelphia area providing both skilled and intermediate care. PARTICIP ANTS: A total of 643 nursing home residents over the age of 60 were en rolled at baseline, and 463 remained to completion (1 year). INTERVENT IONS: Both RE and REC homes received intensive education by a masters- prepared gerontologic nurse to increase staff awareness of restraint h azards and knowledge about assessing and managing resident behaviors l ikely to lead to use of restraints. In addition, the REC home received 12 hours per week of unit-based nursing consultation to facilitate re straint reduction in residents with more complex conditions. MEASUREME NTS: Restraint status was observed systematically at baseline, immedia tely after the 6-month intervention, and again at 9 and 12 months. Sta ff levels, psychoactive drug use, and injuries were also determined. R ESULTS: Compared with baseline, the REC home had a statistically signi ficant reduction in restraint prevalence, whereas RE and C homes did n ot. At 9 months (3 months post-intervention), absolute decline in the percents restrained were 7% RE, 7% C, and 20% REC; at 12 months (6 mon ths post-intervention) declines were 4% RE, 6% C, and 18% REC. However , relative to baseline, these declines represent an average reduction in restraint use of 23% RE, 11% C, and 56% REC. The differences in cha nges over time were consistently significant (P=.01), whether consider ing survivors or those present at each time point, and also when contr olling for differences between groups at baseline. Further, given any change in restraint use, REC residents were between 25% and 40% more l ikely than either RE or C residents to experience decreased restraint use. Results were achieved without increased staff, psychoactive drugs , or serious fall-related injuries. CONCLUSION: A 6-month-long educati onal program combined with unit-based, resident-centered consultation can reduce use of physical restraints in nursing homes effectively and safely. Whether extending the intervention will achieve greater reduc tion is not known from these results.