Can physically restrained nursing-home residents be untied safely? Intervention and evaluation design.

OBJECTIVE To develop an intervention that will enable nursing home personnel to remove physical restraints from nursing-home residents safely and cost effectively. DESIGN A multicenter prospective pre-post study. SETTING Sixteen high-restraint-use nursing homes, four each from California, Michigan, New York, and North Carolina. The 16 facilities have 2075 beds. INTERVENTION A 2-year educational demonstration study, including a 2-day workshop, specially prepared written and video materials, and telephone and on-site clinical consultations. Each nursing home designated a nurse to be the clinical coordinator and to lead a multidisciplinary team in conducting a restraint assessment and devising interventions for removal. OUTCOME MEASURES We compared pre- and post-study aggregate and individual facility rates of restraint use, incidents and accidents, family attitudes, financial impact, serious injuries, and staff attitudes and work patterns. CONCLUSION Preliminary data suggest that this intervention was well received and appears to be effective in achieving restraint-free care.