Evaluation of a multicomponent restraint reduction intervention in care homes

Abstract

ProblemPhysical restraints have been widely applied as a means to prevent accidents among care home residents with cognitive impairment. BackgroundEvidence has shown the risks and harms of physical restraints to the physical and psychosocial health of care home residents. Research on reducing restraint use has been sporadic with inconclusive results. QuestionCan a multicomponent program reduce inappropriate use of physical restraints in care home settings? MethodsA pretest–post-test study was conducted in two care homes in Hong Kong. The multicomponent program comprised staff education, case conferences, and consultation. Data were triangulated using self-administered questionnaires, observations of restraint use practice, and documentary reviews. The following study outcomes were evaluated at baseline and 12-month follow-up: care home staff's use of restraints, knowledge of physical restraints, and perceived competence in dementia care. FindingsRestraint use was reduced by 30.9% in 12 months (p < .001), but no significant difference in the mean scores of knowledge of physical restraints and perceived competence in dementia care was noted among care home staff between baseline and the 12-month follow-up (p = .387 and p = .287, respectively). DiscussionThe findings suggest that our multicomponent program, underpinned by organisational support, was instrumental in reducing the use of physical restraints in care home settings, but its effects on care home staff and residents remain unclear. ConclusionThis study suggests the feasibility and preliminary effects of using a multicomponent program to reduce restraint use in care homes. A more robust study design is needed to evaluate the sustained effects of our multicomponent program and also its effects on the outcomes of care home staff and residents.