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Implementing Restraint Minimization Practices in a 30-Bed High-care Dementia Unit: A Best Practice Implementation Project

Murray, Robyn

doi: 10.1097/01.JBI.0000405542.97161.e5
Departments: Evidence in Action: Peer Reviewed Article

Background The awarding of an Aged Care Clinical Fellowship through the Joanna Briggs Institute (JBI) provided an opportunity to examine restraint practices and implement evidence-based strategies aimed to minimize the use of physical restraint within a 30-bed high-care dementia setting. Utilizing the Practical Application of Clinical Evidence Systems (PACES), an online continuous quality improvement program, an audit was conducted to measure compliance against four best practice standards.

Barriers to implementation were identified using the JBI Getting Research into Practice (GRIP) principles to support staff to apply evidence-based practice into care delivery for residents. This paper describes the journey of audit, implementation of strategies to support the application of evidence-based practice, and reaudit and evaluation of results.

Aims/Objectives The identified aims of the project were to improve local practice in the management of physical restraint, and to support staff through education and review of the organization's procedure and supporting suite of assessment tools to ensure decisions to apply restraint are based in best practice evidence, with the priority being to minimize the use of physical restraint use. It was anticipated that the successful strategies utilized in the project would be replicated across the organization.

Methods The process of audit, feedback, and reaudit using the PACES model was utilized for the project. Identifying a number of barriers to compliance allowed for change management strategies to be developed and implemented in response to the barriers. Required resources were identified; an education package developed and delivered to staff, and complete review of the organizational procedure and assessment tools was undertaken and trialled in the project setting. Reaudit of the four best practice standards was undertaken at the end of the project in order to measure changes to compliance and to evaluate whether the project aims had been met.

Results The results demonstrate levels of compliance pre and post implementation of the strategies implemented for improved compliance against audit criteria. All areas showed improvement in the follow-up audit, with the greatest improvement being in the area of staff education.

Discussion/Conclusion The project confirmed that an ongoing commitment is required in order to achieve sustainable results. Although much has been achieved throughout the duration of the project, the journey towards restraint minimization has just begun. The process of audit, feedback, and reaudit is an effective tool in implementing and measuring changes to compliance utilizing the PACES and GRIP tools in the application of evidence-based practice.

Find out how a dementia unit implemented best practice in their restraint minimization practices to improve care delivery for residents.

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Acknowledgements: Thanks for the outcomes achieved in the project go to the Joanna Briggs Institute, particularly Zuben Florence, facilitator. Also to Frome Wing staff, colleagues, residents, and families from Helping Hand Aged Care.

© 2011 Lippincott Williams & Wilkins, Inc.
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