Use of physical restraints in nursing homes: Current practice in Singapore

Geriatric Medicine Unit, Singapore General Hospital, Singapore.
Annals of the Academy of Medicine, Singapore (Impact Factor: 1.15). 03/2005; 34(2):158-62.
Source: PubMed


One of the indicators of quality care in nursing homes is the proper use of physical restraints. Restraints have been associated with multiple complications, such as pressure ulcers, incontinence and immobility. The aim of our study was to assess the indication, use and complications related to physical restraints in Singapore nursing homes.
All residents aged >65 years old from 3 nursing homes were included in the study. A geriatrician reviewed the medical records of all elderly residents on restraints. Nursing staff interviews were also done to assess their knowledge regarding restraint use. A brief medical record review was also done for the elderly residents without restraints.
Out of 390 elderly residents, 91 were on physical restraints. The mean age of these residents were 80.1 years; 67% were female, 90.1% were Chinese and 82.4% belonged to functional category IV. Both urinary and faecal incontinence were observed in 97.8% of residents. Forty-six (50.5%) residents had no documented indication for restraints. It was noted that 20 (22%) residents were restrained to prevent dislodgement of the feeding tube, 17 (18.7%) were restrained to prevent falls and 8 (8.8%) were restrained for agitation. There were documented trials of removal of restraints for only 21 (23.1%) residents. Alternative approaches, such as diversion technique, were used for 31 (34.1%) residents to avoid restraint use.
Our study revealed a high rate of restraint use in the nursing homes. A restraint protocol should be available in every nursing home, requiring physician approval for the long-term application of physical restraints and intermittent reviews by physicians to assess the continued need for restraints.

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    • "In another study, (Hennessy et al., 1997) found that the improvement of restraint guidelines enhanced the quality of care and also made the work of staff easier. It has also been recommended that restraint protocols and policies be implemented in every nursing home and any long-term physical restraint needed ongoing review and assessment (Mamun & Lim, 2005). This study did not canvass any educational needs other than the implementation of policy and protocol. "
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    • "The rate of physical restraint use in nursing homes has frequently been characterized as unduly high or problematic in recent reviews of the research literature (Castle and Mor, 1998; Guttman et al., 1999; Hamers and Huizing, 2005), and in a variety of countries (Hamers et al., 2004; Huizing et al., 2007; Kirkevold et al., 2004; Mamun and Lim, 2005; Retsas, 1998; Retsas and Crabbe, 1998). Studies have repeatedly documented the adverse sequelae associated with physical restraints, including falls, nosocomial infection, pressure ulcers, psychiatric morbidity, mental health problems, aggressive behavior and mortality (Castle, 2006; Castle and Mor, 1998; Hamers and Huizing, 2005; Ryden et al., 1999). "
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