title: Compliance with best practice: implementing the best available evidence in the use of physical restraint in residential aged care.
abstract: The Aged Care Clinical Fellowship, funded by the Commonwealth Department of Health and Ageing and conducted through the Joanna Briggs Institute is an initiative designed to improve the care of older Australians through clinical leadership and promotion of best practice. This paper outlines one of the projects undertaken at Carinya of Bicton, a residential aged high care facility, using an audit and feedback process to implement best practice standards in the use of physical restraint. Aims  Between 12% and 47% of residents in residential care facilities are restrained; however, initial observation of residents restrained in the project facility showed that restraint devices were utilised in up to 40% of residents. Within the aged care sector there has been a shift in attitude to reducing or eliminating restraint in aged care facilities. Restraint is seen as a negative experience for the resident, being associated with physical discomfort, embarrassment and restriction of freedom and of movement. The purpose of the project was to improve practice in the area of physical restraint through the process of auditing current practice against evidence-based, best practice criteria and ultimately to reduce the level of restraint in the facility. Methods  This practice improvement project utilised an audit and implementation cycle. The Joanna Briggs Institute Practical Application of Clinical Evidence System and best practice criteria developed from a systematic review were used to determine compliance with best practice. The Getting Research into Practice module was then employed to develop strategies to improve practice. Results  The follow-up audit indicated there has been a reduction in the number of residents restrained, increased use of alternatives to restraint and an awareness on the part of all care staff of the policies and procedures, which govern the use of restraint in the facility. Conclusions  It is recognised that the success of this project is in part due to the focus of all staff in the area and the support and assistance given to staff by management and the project team. This support will need to continue because while practice has improved in the short term, there are still barriers to change in this area. Also of benefit has been a shift in emphasis of the continuous quality improvement program at the facility to a more clinical focus. Management and staff, especially members of the project team have agreed that this process be utilised to improve practice in a number of other areas such as falls, constipation and behaviour management.
authors.affiliation: Carinya of Bicton, 41 Bristol Avenue, Bicton, Western Australia 6157, Australia.
authors.forename: Janet
authors.initials: J
authors.lastname: Timmins