Restraint reduction reduces serious injuries among nursing home residents
Restraint reduction reduces serious injuries among nursing home residents
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DOI：
10.1111/j.1532-5415.1999.tb05200.x
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发表时间：
1999-10-01
影响因子：
6.3
通讯作者：
Breuer, B
中科院分区：
文献类型：
--
作者：
Neufeld, RR;Libow, LS;Breuer, B
目的：描述如何消除身体约束影响伤害护理hospitalsettings.DESIGN：一个为期2年的前瞻性研究的教育干预身体约束reduction.SETTING：十六个不同的疗养院2075张病床在加州，密歇根州，纽约，和北卡罗来纳州。参与者：研究A：859名居民谁是身体约束的干预开始于1991年10月1日。研究B：干预前3个月和干预完成后3个月，在16个设施中占用2075张床位的所有居民。干预：护理之家工作人员的教育计划，随后每季度对参与护理之家进行现场咨询。主要结果指标：身体约束使用率和伤害率。结果：研究A：当限制令被终止时，859名最初被限制的居民中的严重伤害显着下降（卡方（2）= 6.2，P = 0.013）。研究B：在干预期间，2075名居民中使用身体约束的比例从41%下降到4%，下降了90%。中度至严重程度的伤害百分比的下降是显著的（即，7.5%vs 4.4%，P2-tail = 0.0004），中度和重度伤害的比率也是如此（比率= 1.580，P2-tail = 0.0033）。结论：在没有严重伤害增加的情况下，约束使用的大幅减少。虽然轻伤和福尔斯跌倒的情况有所增加，但在进行全面评估并使用约束替代品时，无约束护理是安全的。
OBJECTIVES: To describe how removing physical restraints affected injuries in nursing home settings.DESIGN: A 2-year prospective study of an educational intervention for physical restraint reduction.SETTING: Sixteen diverse nursing homes with 2075 beds in California, Michigan, New York, and North Carolina.PARTICIPANTS: Study A: 859 residents who were physically restrained at the onset of the intervention on October 1, 1991. Study B: all residents who occupied the 2075 beds in the 16 facilities 3 months before the intervention and 3 months after its completion.INTERVENTION: Educational program for nursing home staff followed by quarterly site consultations to participating nursing homes.MAIN OUTCOME MEASURES: Rate of physical restraint use and injuries.RESULTS: Study A: Serious injuries declined significantly among the 859 residents restrained initially when restraint orders were discontinued (chi(2) = 6.2, P = .013). Study B: During the intervention period, physical restraint use among the 2075 residents decreased from 41% to 4%, a 90% reduction. The decrease in the percentage of injuries of moderate to serious severity was significant (i.e., 7.5% vs 4.4%, P2-tail = .0004) as was the rate of moderate and serious injuries combined (Rate Ratio = 1.580, P2-tail = .0033).CONCLUSIONS: A substantial decrease in restraint use occurred without an increase in serious injuries. Although minor injuries and falls increased, restraint-free care is safe when a comprehensive assessment is done and restraint alternatives are used.