title: Progress toward a restraint-free environment in a large academic nursing facility.
abstract: OBJECTIVE
  To review the implementation and evolution of a successful physical restraint reduction program in a large nursing facility.
  
  
  METHODS
  An initiative to reduce physical restraint began in March of 1990 with formation of a Restraint Review Committee (RRC), which developed and guided a program of inservice education, policy change, and procedural innovation. Progress was measured by monthly prevalence surveys of restraint use, both unit-specific and facility-wide.
  
  
  METHODS
  The study took place in an 816-bed not-for-profit nursing facility with academic affiliation and closed medical staff. Mean age of residents was 85.5; 74% were female and 26% male.
  
  
  RESULTS
  Physical restraint prevalence in our facility was reduced from 39% to 4% over 3 years, with marked decrease in variation among nursing units. Prevalence initially decreased to 20% after policy modifications and inservice education programs. Further innovations in procedure and policy resulted in continued reduction of physical restraint to 4%. The facility-wide rate of falls and accident-related injuries did not change over the 3-year period. Decrease in physical restraint was not accompanied by a change in the percentage of residents prescribed psychotropic medications such as benzodiazepines and neuroleptics.
  
  
  CONCLUSIONS
  In response to the mandate to provide a least-restrictive environment, our institution has developed a successful system resulting in a dramatic reduction in physical restraint use. Changes in institutional culture and barriers to change are discussed, as well as issues of cost and generalizability.
authors.affiliation: Jewish Home and Hospital for Aged, Bronx, New York 10468, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Levine
authors.forename: V
authors.initials: V
authors.lastname: Marchello
authors.forename: E
authors.initials: E
authors.lastname: Totolos
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D009519:New York City / Q000453:epidemiology; D009936:Organizational Innovation; D016134:Organizational Policy; D010348:Patient Care Team; D011367:Professional Staff Committees / Q000458:organization & administration; D016730:Program Development; D015397:Program Evaluation; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012149:Restraint, Physical / Q000009:adverse effects / Q000379:methods
chemical_list: D011619:Psychotropic Drugs