TIP OF THE WEEK
Reducing the Use of Physical Restraints
In many cases, restraint use in long-term care can present key patient safety issues. Research and standards of practice show that the belief that restraints ensure safety is often unfounded. In practice, restraints have many negative side effects and risks that outweigh the benefits in some cases.1 Consider the following:
- As many as 200 deaths occur every year as a result of strangulation or suffocation from restraints, even when they are applied according to manufacturers’ instructions.2
- Physical restraints not only may not prevent falls, but can cause greater harm including strangulation, loss of muscle tone, decreased bone density (with greater susceptibility for fractures), pressure sores, decreased mobility, depression, agitation, loss of dignity, incontinence, constipation, and in some cases, resident death.3
- The Ohio Department of Health (ODH) states that restraints can limit an individual’s self-determination and independence, and can be directly linked to loss of function.4 ODH also reports that there are some less obvious effects of restraints.5 These include:
- Feelings of isolation and dehumanization
- Withdrawal, agitation, and depression
- Loss of appetite
- Bowel and bladder problems
- Decreased bone and muscle strength
- Development of skin problems
- Resignation to loss of freedom and dignity
- Increased dependence
- Loss of mobility
- Increased risk of strangulation
- Feeling of entrapment
National goals have been set by the Centers for Medicare & Medicaid Services (CMS) for nursing homes to reduce their physical restraint quality measure scores to 0-2 percent. Currently, the national average for this quality measure is 5 percent; Ohio nursing homes currently average 6 percent.6
SUCCESSFUL RESTRAINT REDUCTION
The success of a restraint elimination program is dependent upon the support of the administrator, director of nursing, family, and health team members.7 According to Williams and Finch, this may be the single most important element of a successful restraint-free program.8 Dunbar et al. observed “that one of the most important factors in reducing the use of restraints was the attitude and commitment of administrators to be knowledgeable about restraint-free care, willing to advocate for its implementation, and able to guide and lead their facilities through the process.”9
RESTRAINT ALTERNATIVES
The American Geriatrics Society (AGS) states that restraint-free environments necessitate consideration of various alternative measures for preventing and managing problematic behaviors. Measures such as cushions and pads, enhanced physical therapy and recreational activities, environmental manipulations, and increasing staff attention may successfully lessen wandering and prevent injury to patients who might otherwise have been restrained. Some helpful approaches include: staff education, multidisciplinary teams that deal only with issues of restraints and restraint reduction, strong interpersonal relationships among residents and caregivers, and knowledge of proper communication techniques for all types of residents.10
RESOURCE SPOTLIGHT
RESTRAINT TOOLKIT
The Texas Medical Foundation’s Restraint Toolkit identifies four key steps to reducing the use of restraints: (1) Data collection; (2) Assessment and treatment; (3) Interventions; (4) Evaluations and reassessment.
IN THE NEWS
GOOD KIDNEY TRANSPLANTATION OUTCOMES POSSIBLE IN ELDERLY ADULTS
March 3, 2008 -- Medscape -- According to findings published in the February 2008 Journal of the American Geriatric Society, elderly adults can do well following kidney transplantation, although careful donor selection may be critical in achieving good outcomes when significant comorbidities are present. | Read the release | Read the abstract
NEW IFAS REPORT EXAMINES DIABETES IN U.S. NURSING HOMES
March 4, 2008 -- IFAS -- A new report of the Institute for the Future of Aging Services (IFAS) shows that one in four U.S. nursing home residents aged 65 and older has diabetes. This report also examined the association between diabetes and ethnicity, activities of daily living, source of admission, payment sources, length of stay (LOS), pressure ulcers, emergency department visits, and medication usage. | Read the release | Download the report
INDUSTRY EVENTS
NAVIGATING THE MDS THROUGH THE OHIO MEDICAID REIMBURSEMENT SYSTEM
May 1, 2008, 8:30 a.m. to 4:45 p.m. ET
Speakers: Claire Spellmire, RN, BSN, and Karen Jennings, LNHA, MHA, from the Case Mix Section, Bureau of Long Term Care Facilities, Office of Ohio Health Plans.
Cost: Free
For more information or to register, call Cheryl Robertson at (614) 466-9088.
Space is limited to two per facility.
Cuyahoga Community College Spring ’08 Continuing Education Schedule for Gerontology Professionals
Health Policy Institute of Ohio: Regional Meetings on the Ohio Family Violence Prevention Project
- March 14th in Athens
- April 4th in Youngstown
- April 11th in Cleveland
- May 2nd in Toledo
- May 9th in Lima
- May 16th in Cincinnati
- May 23rd in Zanesville
Medicare Learning Network: Learning resources and products for the healthcare professional.
Alzheimer’s Association Training Events
Case Western Reserve University School of Medicine Courses
Ohio Department of Health, Technical Assistance Program – New Programs
Ohio Health Care Association Events
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