The Ethical Use of Medical Restraints – The Goal is Restraint Free Care

In 1990, about 30-40% of nursing home residents in the US were restrained. In 2001, less than 9% of nursing home residents were currently restrained. We are slowly getting better at keeping our patients out of restraints in both nursing homes and in hospitals. But we still have room for improvement. In Europe, the rate is less than 5%. The difference between the countries is not what kind of patient is in restraints but what the standard of care of is in that particular country. The good news is that with the reduction of medical restraint use, there has been a significant decrease in patient injuries and deaths.

Ultimately our goal needs to be restraint-free care. As a loved one of the patient, you should be an active participant in helping the staff keep your loved one free of restraints. How do you do this? Here are a few suggestions. The first thing to realize is that there is no one-size fits all solution. No two patients are exactly alike regardless of the diagnosis or the problem. You will want to personalize the solution for your loved one, not the generic patient.

The next thing you want to do is to ask, “Why are they acting like this? What is going on?” Too often we rush to thinking the person has dementia or some other mental deficit, when really the issue might be a reaction to a new medication, untreated pain or some other disease showing up. The sooner you can identify why the bad behavior is showing up, the sooner you will be able to brainstorm to find an appropriate solution. The solution should match the personality of the patient. Are they a patient who has always loved music, done crafts, liked having pictures of their family around, liked to listen to the radio etc. Then choose distractions and solutions that will fit their lifestyle.

You may have to try multiple interventions before you will find one that works. Don’t give up if the first thing you try doesn’t work. Please make the effort to find other solutions rather than tying up your love ones. You wouldn’t want to be tied up against your will and neither do they.

For a great handbook on reducing the use of restraints go to http://www.theconsumervoice.org/node/477.

Have a kind and respectful day.