PHYSICAL RESTRAINT REDUCTION IN LONG-TERM CARE: IMPLEMENTATION OF A GUIDELINE-BASED PROGRAM

Despite evidence on unintended consequences, physical restraints continue to be part of standard care. We implemented a successfully tested guideline-based multicomponent program on physical restraints reduction into routine long-term care. We performed a before-after study in home care services and nursing homes of one health care provider in northern Germany. The intervention, originally developed for nursing homes, was adapted for use in home care. Four one-day nurse training courses were conducted. Participating facilities received the evidence-based guideline, associated materials and structured telephone counselling. Prior to the first training and after one year, the percentage of care recipients with at least one physical restraint was assessed by direct observation. Nine home care facilities and 15 nursing homes with 1,490 care recipients took part in the study and 34 nurses were trained. In nursing homes, the number of residents with physical restraints was reduced from 11.1% to 5.7% (reduction 5.4%, 95%CI: 2.1–8.6, p=0.001). In home care, the number was reduced from 6.1% to 3.8% (reduction 2.3%, 95%CI: 0.4–4.3, p=0.021). In conclusion, the guideline-based program was successfully adapted and implemented for the needs of home care services and nursing homes of one large care provider in Germany. However, not all services could be equally reached by the intervention. Regular training and updates are necessary for permanent implementation.