ALTERNATIVES TO RESTRAINT USE

Underlying Principles for Reducing Restraint Use

Resident Assessment. In depth assessment of resident by interdisciplinery team including: nurse; physician' dietitian; social worker; pharmacologist; occupational, physical and speech therapist; and activities professional. Identification of strengths and weaknesses, including lifelong habits, daily routine, activities of daily living, mood, attitude, memory, communication, disease states, activities and medications. Assessment is continuous and ongoing throughout the stay.

Individualized Care Plan. Plan based on strengths and deficits identified by assessment. Include resident and/or family or legal representative and nurse aide in care planning conference. The care plan must meet individualized resident needs and change as resident needs change.

Teamwork. No one person or discipline has all the answers. Ideas may come from professional or non-professional direct care givers, indirect caregivers, volunteers, family and other residents.

OPTIONS FOR ACTION TO AVOID RESTRAINT USE-GENERAL

Companionship and supervision including the use of volunteers, family, friends, etc.
Physical and diversionary activity such as exercise, outdoor time, activities that resident would like to do, small jobs agreed to by the resident
Psychosocial interventions including meeting lifelong habits and patterns of daily activity
Environmental approaches; alarms, good lighting, reduced glare, mattress on floor to reduce falls, individualized seating
Meeting identified physical needs such as hunger, toileting, sleep, thirst and exercise according to individual routine rather than facility routine
Training staff to meet individualized needs
Staffing levels high enough to comply with the law which requires enough staff to meet residents' mental, physical and psychosocial needs. Use heavier staffing during peak periods of day
Administrative support so that flexibility in routines is the norm in order to accommodate individual needs

SPECIFIC PROGRAMS FOR REDUCING RESTRAINT USE

Restorative care program including walking, bowel and bladder, independent eating, dressing, bathing programs.
Wheelchair management program to assure correct size is used and the condition of the chair remains intact.
Individualized seating program for those residents who do not need wheels for mobility. Chairs should be tailored, the same way as wheel chairs, to individual needs.
SERVE program (self esteem, relaxation, vitality and exercise), including fun, relaxation, stretching, range of motion and walking.
Specialized programs for residents with dementia, designed to increase their quality of life during the day.
Video visits - videotaped family visits when families live far away.
Outdoor program every morning and afternoon in nice weather. Two aides assigned to take care of residents using enclosed outdoor area.
Rehabilitation dining room to help residents increase mealtime skills and independence.
Wandering program to allow safe wandering while preserving the rights of others.
Preventive program for calming aggressive behaviors based on knowing the resident, preventing triggering of aggression and using protective intervention as a last resort.
Enhancement project: a program to improve the quality of residents' lives, run by certified nursing assistants.

IMPLEMENTATION OF PROGRAM FOR DECREASED RESTRAINT USE

Support of owner/operator Board of Directors to care for residents more humanely.
Support of professional caregiving staff who can be challenged to creatively think of new ways to identify and meet residents' needs.
Education for all staff on each person's role in decreasing restraint use.
Allaying fears of families who have been taught that residents must be restrained for safety.
Closer involvement of social worker, activities director, pharmacologist, various therapies, volunteers and family.
Flexibility in staff use, including permanent staff assignments.
Remove easiest restraints first in order to have success.

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