title: Restraint reduction reduces serious injuries among nursing home residents.
abstract: OBJECTIVE
  To describe how removing physical restraints affected injuries in nursing home settings.
  
  
  METHODS
  A 2-year prospective study of an educational intervention for physical restraint reduction.
  
  
  METHODS
  Sixteen diverse nursing homes with 2075 beds in California, Michigan, New York, and North Carolina.
  
  
  METHODS
  Study A: 859 residents who were physically restrained at the onset of the intervention on October 1, 1991. Study B: all residents who occupied the 2075 beds in the 16 facilities 3 months before the intervention and 3 months after its completion.
  
  
  METHODS
  Educational program for nursing home staff followed by quarterly site consultations to participating nursing homes.
  
  
  METHODS
  Rate of physical restraint use and injuries.
  
  
  RESULTS
  Study A: Serious injuries declined significantly among the 859 residents restrained initially when restraint orders were discontinued (X2 = 6.2, P = .013). Study B: During the intervention period, physical restraint use among the 2075 residents decreased from 41% to 4%, a 90% reduction. The decrease in the percentage of injuries of moderate to serious severity was significant (i.e., 7.5% vs 4.4%, P2-tail = .0004) as was the rate of moderate and serious injuries combined (Rate Ratio = 1.580, P2-tail = .0033).
  
  
  CONCLUSIONS
  A substantial decrease in restraint use occurred without an increase in serious injuries. Although minor injuries and falls increased, restraint-free care is safe when a comprehensive assessment is done and restraint alternatives are used.
authors.affiliation: The Commonwealth National Restraint Minimization Project, New York, New York, USA.
authors.forename: R R
authors.initials: RR
authors.lastname: Neufeld
authors.forename: L S
authors.initials: LS
authors.lastname: Libow
authors.forename: W J
authors.initials: WJ
authors.lastname: Foley
authors.forename: J M
authors.initials: JM
authors.lastname: Dunbar
authors.forename: C
authors.initials: C
authors.lastname: Cohen
authors.forename: B
authors.initials: B
authors.lastname: Breuer
mesh_terms: D000368:Aged; D032763:Behavior Control; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015577:Geriatric Assessment; D006282:Health Personnel / Q000193:education; D006801:Humans; D015601:Injury Severity Score; D009735:Nursing Homes; D011446:Prospective Studies; D012149:Restraint, Physical; D014947:Wounds and Injuries / Q000453:epidemiology / Q000517:prevention & control*