Registed Nurses' Association of Ontario

Evidence Booster: Becoming restraint-free - The impact on falls rate

The Ontario Long-Term Care Homes (LTCH) Act, 2007 requires all LTC homes to have a program to minimize restraints. The rationale cited for not becoming restraint-free are: a) falls rate will rise, b) understaffing, and c) family members who insist on use. Research demonstrates more serious injury and increased mortality rates with restraint use (Cleary & Scott, 2015).

The prevalence of the use of restraints varies considerably among LTC homes. Provincial data from Health Quality Ontario (HQO) reveals a steady decline in restraint use since 2011 with the enactment of the LTCH Act. The average rate of restraint use decreased from 13.9 per cent in 2011/12 to 5.1 per cent in 2016/17 (HQO, 2018a). Interestingly, over the same period falls rate have increased by 11 per cent (HQO, 2018b). Given that provincial data aggregates all LTCHs, it is impossible to distinguish between LTCHs with a restraint minimization program and those who are restraint free. This evidence booster highlights the impact on resident and family outcomes when LTCHs adopt a restraint free approach to care.

Practice Change
Novel approaches used included:

  1. Involving the programming staff during shift change
  2. Updating call bell system to link fall alarms and call bells to mobile devices
  3. Physiotherapist (PT) and PT assistant work with families on admission, at 6-week and annual care conferences
  4. Changed PSWs start time (1-hour earlier)
  5. Daily huddles on all shifts
  6. Discussions prior to admission