Limiting restraints essential for promoting safety in long-term care, say experts
Clinicians say providers and families need more education about safety devices
Tuesday November 18, 2008 -- Deron Hamel
Two patient-safety experts say long-term care providers need to consider policies limiting the usage of restraints and side rails in nursing homes in an effort to promote and improve safety throughout the sector.

Contrary to popular belief, devices such as wheelchair seat belts and side rails fixed to beds can increase the risk of injury and even death if used in a long-term care setting, according to research conducted by Dr. Laura Wagner and Dr. Liz Capezuti.

Both experts say the key to enhancing safety for residents in long-term care homes is education. By educating providers about the dangers of restraints and side rails, as well as passing on this information to residents’ families, who must give consent for restraints to be used, Wagner and Capezuti say many risks would be minimized.

Wagner, a nursing scientist specializing in patient-safety research at Baycrest in Toronto, says it is a “myth” that these devices reduce the risk of injury.

“I think (the myth) comes from care providers thinking that (wheelchair seat belts) are protective, and also from family members who are misinformed,” she says.

“I think families need to be informed about the risks associated with restraints and side rails, so there needs to be better communication upon admission and throughout the process — especially about the alternatives which are available. Often, I think that family members don’t know that there are other alternatives to preventing falls.”

Some of these alternatives include promoting the use of walkers and canes, lowering beds and placing fall mats on the floor beside beds.

There are also many proactive interventions which can be used by long-term care providers, including physiotherapy and exercise programs, which foster increased mobility and improve balance.

Because light and sound can cause agitation, Wagner recommends long-term care homes reduce noise and light levels at night to diminish the risk of residents trying to get out of bed. Wagner also recommends homes ensure there is always a bedside commode present.

Adding to this, Wagner says care providers need to take an individualized approach to reducing the risk of falls, rather than implementing one-size-fits-all measures.

“You need to look at (each) resident and what their unique needs are and see what kinds of alternatives would be a fit for them,” she says. “If it doesn’t work for them, then try something else before using a restraint.”

Capezuti, a professor and co-ordinator of the Hartford Institute for Geriatric Nursing at the New York University College of Nursing, presented her research on this issue at the eighth annual Kunin-Lunenfeld Applied Research Unit Conference held in October at Baycrest.

Capezuti says her message at the conference was that falls and injuries can be prevented without using restraints or side rails.

“That was the main message — we can do it, there is research that supports this we know the dangers of these devices, so we really need to do everything we can not to use them and to use alternatives,” says Capezuti.

Aside from using alternatives to restraints to promote safety, Capezuti notes that long-term care providers can do small things to promote the balance between safety and quality of life in their homes. It starts, she says, with making homes feel less institutional.

“I think in the nursing home setting if we can become more homelike . . . I think that balance would then become easier,” says Capezuti, adding she applauds the fact that many long-term care providers are already doing this.

“When we try to control everything and it becomes more like a hospital medical unit (than a home), that’s when we (begin) to use these kinds of devices,” she says.

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