Registed Nurses' Association of Ontario

Implementation Resources

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When Jane Rosenberg was a nursing student, using restraints was common practice. "Although I wasn't comfortable using restraints, I followed orders," she recalls. In those days, it was frowned upon for nursing students to rock the boat. But she knew restraints threatened the dignity of her residents, so she made a quiet commitment to pursue a change.

Approximately 1.53 million Ontarians are living with diabetes and between 16,600 and 27,600 may develop a diabetic foot ulcer (DFU).1 The direct healthcare costs for DFU are between $320 to $400 million and indirect costs are between $35 to $60 million.1 Offloading devices (devices that relieve pressure) have demonstrated substantial cost savings. An offloading device can cost between $100 (removable cast walker) to $1,500 (total contact casting), as opposed to $70,000 per amputation. The estimated cost savings for Ontario is between $48 to $75 million per year due to saved limbs.

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 annual direct health-care costs are estimated to be CAD $2 billion due to falls, with older adults accounting for nearly half of these costs. In 2012, the average cost for a serious injurious fall was estimated to be CAD $31,000  when compared to a patient with no falls treated for similar diagnosis. This reflected direct and indirect in-patient costs of 34 days in the hospital with nursing care and excluded physician billing.