Belt restraint reduction in nursing homes: effects of a multicomponent intervention program.

Objectives: To test the effects of a multicomponent intervention program to reduce the use of belt restraints in psychogeriatric nursing homes.

Design: A quasi-experimental longitudinal design. Study duration was 8 months.

Setting: Twenty-six psychogeriatric nursing home wards in 13 Dutch nursing homes were assigned to intervention or control groups.

Participants: Seven hundred fourteen residents were selected for participation. Legal representatives of 520 residents agreed on participation; complete data are available for 405 residents.

Intervention: The intervention program included four major components: promotion of institutional policy change that discourages use of belt restraint, nursing home staff education, consultation by a nurse specialist aimed at nursing home staff, and availability of alternative interventions.

Measurements: The primary outcome measure was the frequency of belt restraint use. Secondary outcomes included other types of physical restraints, psychoactive drug use, falls, and fall-related injuries. These data were collected at baseline and after 4 and 8 months. A trained, blinded observer measured the use of belts and other physical restraints types four times during a 24-hour period.

Results: The intervention resulted in a 50% decrease in belt use (odds ratio = 0.48, 95% confidence interval = 0.28-0.81; P = .005). No increase occurred in the use of other types of restraints. No marked differences between the groups were found regarding psychoactive drugs, falls, and fall-related injuries.

Conclusion: A multicomponent intervention program led to a substantial reduction in use of belts, full-enclosure bedrails, and sleep suits without increasing the use of other physical restraints, psychoactive drugs, or falls and fall-related injuries.