Physical restraint deaths in a 13-year national cohort of nursing home residents

Bellenger, Emma N.; Ibrahim, Joseph E.; Bugeja, Lyndal; Kennedy, Briohny

doi:10.1093/ageing/afw246

Cited by 24 publications

(21 citation statements)

References 17 publications

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“…In addition, some care staff reported that physically restraining residents were effective in preventing falls, but this is not a practice supported by the evidence (Australian Commission on Safety & Quality in Health Care, ; Australian Government Department of Health & Ageing, ). It is known that restraints may even cause harm and compromise effective delivery of person‐centred care, again compromising resident safety (Australian Government Department of Health & Ageing, ; Bellenger, Ibrahim, Bugeja, & Kennedy, ). Careful assessment and review of such practices are required at facility, organisation and government levels.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of care staff knowledge, confidence, motivation and opportunity for preventing falls in residential aged care settings: A cross‐sectional survey

Francis‐Coad

Hang

Etherton‐Beer

et al. 2019

Int J Older People Nursing

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Aims:To explore care staff knowledge about falls and confidence, motivation and opportunity to undertake fall prevention strategies, in residential aged care (RAC) along with preferences for fall prevention education.Background: Falls account for the majority of adverse clinical events in RAC settings.Care staff in RAC settings are in a key position to influence residents' actions to prevent falls, provided they have the necessary knowledge and skills. Methods:A cross-sectional survey design with a purposive sample of 147 care staff at eight RAC facilities was undertaken in 2015. A custom-designed questionnaire examining knowledge, confidence, motivation and opportunity to undertake falls prevention strategies was used. Results:Only 39 (26.5%) care staff were aware that the residents they cared for were at high risk of falls. Care staff knowledge of intrinsic falls risk factors was very limited, for example, only 18 (13.53%) observed for side effects of medication and just four (1.04%) were aware of continence issues. Conflicting duties also limited care staff time to undertake falls prevention strategies. Preferences for falls prevention education indicated face-to-face interactive discussions in the workplace (n = 98, [66.7%]) with reminder posters displayed around the facility (n = 80, [70.8%]). Conclusions:Residential aged care organisations need to engage with care staff to provide tailored falls education incorporating learning preferences and targeting knowledge gaps, to improve awareness of intrinsic risk factor impact and uptake of evidence-based prevention strategies. Despite care staff being highly motivated, they have limited opportunity to assist residents with fall prevention within their workload. RAC management and funding bodies must address opportunity for care staff to fulfil this crucial role to benefit resident safety. Implication for practice:This study identified gaps in care staffs' knowledge and skills in undertaking falls prevention strategies in residential aged care settings.These findings will assist residential aged care organisations and health professional educators to design evidence-based falls prevention education tailored to their care staffs' needs and preferences to facilitate adoption.

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Section: Discussionmentioning

confidence: 99%

Evaluation of care staff knowledge, confidence, motivation and opportunity for preventing falls in residential aged care settings: A cross‐sectional survey

Francis‐Coad

Hang

Etherton‐Beer

et al. 2019

Int J Older People Nursing

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“…When physical or chemical restraints of residents have been associated with PU development, it is thought to be likely correlated with the residents’ inability to move to relieve pressure (Mott, Poole, and Kenrick 2005 ; Brower 1993 ). Residents may be restrained physically by belts, vests, and jackets in an effort to protect them from inflicting injury on themselves or others (Ben Natan et al 2010 ; Chaves et al 2007 ; Brower 1993 ) and to prevent residents from falling (Bellenger et al 2017 ). Highly restrictive restraints have been associated with death from asphyxiation (Chaves et al 2007 ), neck compression, and entrapment (Bellenger et al 2017 ).…”

Section: Introductionmentioning

confidence: 99%

“…Residents may be restrained physically by belts, vests, and jackets in an effort to protect them from inflicting injury on themselves or others (Ben Natan et al 2010 ; Chaves et al 2007 ; Brower 1993 ) and to prevent residents from falling (Bellenger et al 2017 ). Highly restrictive restraints have been associated with death from asphyxiation (Chaves et al 2007 ), neck compression, and entrapment (Bellenger et al 2017 ). The development of PUs in restrained residents in RACFs increases the facility’s exposure to legal action (Voss et al 2005 ; Toolan et al 2014 ; Brower 1993 ; Tsokos, Heinemann, and Puschel 2000 ).…”

Section: Introductionmentioning

confidence: 99%

Two-Hourly Repositioning for Prevention of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse?

2019

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For decades, aged care facility residents at risk of pressure ulcers (PUs) have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week (24/7). Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities (RACFs) to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent (73/80) of residents identified as being at risk of PUs and repositioned two-hourly 24/7, 34 per cent (25/73) died with one or more PUs. Behaviours of concern were noted in 72 per cent (58/80) of residents of whom 38 per cent (22/58) were restrained. Dementia was diagnosed in 70 per cent (56/80) of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia (82 per cent v 50 per cent, p = 0.028). The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress.

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“…Bellenger et al (20) Physical N2*** The practice of containment can result in death, as a consequence of mechanical asphyxia, and the main justification for containment is the prevention of falls.…”

Section: Kurata Etmentioning

confidence: 99%

A prática da contenção em idosos: revisão integrativa

Backes¹,

Beuter²,

Venturini³

et al. 2019

Acta paul. enferm.

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Resumo Objetivo Analisar as evidências da literatura sobre a prática da contenção em idosos. Métodos Revisão integrativa de literatura, com busca dos estudos primários publicados de 2013 a 2017, realizada nas bases de dados eletrônicas LILACS e MEDLINE, nos meses de maio e junho de 2018. As buscas foram obtidas pelo cruzamento, nas bases de dados, dos seguintes descritores e palavras: contenção; restrição; restrição física; e idoso. Resultados Foram incluídos 17 artigos e, a análise indicou que as evidências disponíveis na literatura reportam à prática de contenções no cotidiano de idosos, às consequências frente ao uso de contenções em idosos, e a técnicas alternativas ao uso das contenções. Conclusões O uso de contenções, principalmente físicas e químicas, é permeado por maior probabilidade de declínio cognitivo do idoso, além de consequências à saúde física e psicológica, podendo, até mesmo, resultar em óbito. Programas de intervenção e políticas designadas à diminuição do uso de contenções em idosos mostram-se como estratégias alternativas, contribuindo assim, para a qualificação da assistência.

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Physical restraint deaths in a 13-year national cohort of nursing home residents

Abstract: this national study confirms that the use of physical restraint does cause fatalities, although rare. Further research is still needed to identify which alternatives strategies to restraint are most effective, and to examine the reporting system for physical restraint-related deaths.

Cited by 24 publications

References 17 publications

Evaluation of care staff knowledge, confidence, motivation and opportunity for preventing falls in residential aged care settings: A cross‐sectional survey

Evaluation of care staff knowledge, confidence, motivation and opportunity for preventing falls in residential aged care settings: A cross‐sectional survey

Two-Hourly Repositioning for Prevention of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse?

A prática da contenção em idosos: revisão integrativa

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