Belt restraint reduction in nursing homes: effects of a multicomponent intervention program.

OBJECTIVES To test the effects of a multicomponent intervention program to reduce the use of belt restraints in psychogeriatric nursing homes. DESIGN A quasi-experimental longitudinal design. Study duration was 8 months. SETTING Twenty-six psychogeriatric nursing home wards in 13 Dutch nursing homes were assigned to intervention or control groups. PARTICIPANTS Seven hundred fourteen residents were selected for participation. Legal representatives of 520 residents agreed on participation; complete data are available for 405 residents. INTERVENTION The intervention program included four major components: promotion of institutional policy change that discourages use of belt restraint, nursing home staff education, consultation by a nurse specialist aimed at nursing home staff, and availability of alternative interventions. MEASUREMENTS The primary outcome measure was the frequency of belt restraint use. Secondary outcomes included other types of physical restraints, psychoactive drug use, falls, and fall-related injuries. These data were collected at baseline and after 4 and 8 months. A trained, blinded observer measured the use of belts and other physical restraints types four times during a 24-hour period. RESULTS The intervention resulted in a 50% decrease in belt use (odds ratio = 0.48, 95% confidence interval = 0.28-0.81; P = .005). No increase occurred in the use of other types of restraints. No marked differences between the groups were found regarding psychoactive drugs, falls, and fall-related injuries. CONCLUSION A multicomponent intervention program led to a substantial reduction in use of belts, full-enclosure bedrails, and sleep suits without increasing the use of other physical restraints, psychoactive drugs, or falls and fall-related injuries.