ABSTRACT
OBJECTIVE: To review the implementation and evolution of a successful physical restraint reduction program in a large nursing facility. INTERVENTION AND MEASUREMENTS: 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. PATIENTS AND SETTING: 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.
Subject(s)
Academic Medical Centers/organization & administration , Homes for the Aged/organization & administration , Restraint, Physical , Accidental Falls/statistics & numerical data , Aged , Aged, 80 and over , Female , Humans , Male , New York City/epidemiology , Organizational Innovation , Organizational Policy , Patient Care Team , Professional Staff Committees/organization & administration , Program Development , Program Evaluation , Psychotropic Drugs/therapeutic use , Restraint, Physical/adverse effects , Restraint, Physical/methodsABSTRACT
Pressure ulcers are common in frail, disabled, or acutely ill older patients in the home, hospital, or nursing home. Prevention is the most important aspect of pressure ulcer care, and physician and nurse share in this responsibility. A nosocomial pressure ulcer adds significantly to mortality, morbidity, and hospital length-of-stay. Risk factor assessment scales can help identify patients who need prevention efforts, such as pressure relief, incontinence care, and nutritional supplements. When an ulcer does occur, careful documentation is required, including staging, size and depth description, and review of the interdisciplinary care plan. Knowledge of wound biology and cost-effectiveness should guide the choice of wound healing products.
Subject(s)
Pressure Ulcer/prevention & control , Aged , Aged, 80 and over , Bedding and Linens , Health Status , Humans , Male , Ointments , Pressure Ulcer/etiology , Pressure Ulcer/therapy , Risk Assessment , Wound HealingABSTRACT
The Jewish Home and Hospital for Aged, Bronx Division, is an 816-bed nursing facility that has developed a strategy for pressure ulcer management which relies on documentation, data flow, and feedback. Our system incorporates principles of Quality Improvement, and has resulted in a remarkably low nosocomial ulcer prevalence rate of 3.1%. We discuss Quality Improvement in the nursing facility and examine the value of pressure ulcer prevalence as a quality indicator. We present details of our system, highlighting the flow of information which comprises the Quality Improvement infrastructure, and include a discussion of benefits and costs of our system.
