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:
- Involving the programming staff during shift change
- Updating call bell system to link fall alarms and call bells to mobile devices
- Physiotherapist (PT) and PT assistant work with families on admission, at 6-week and annual care conferences
- Changed PSWs start time (1-hour earlier)
- Daily huddles on all shifts
- Discussions prior to admission
Related BPG:
Preventing Falls and Reducing Injury from Falls, Fourth Edition
Promoting Safety: Alternative Approaches to the Use of Restraints
