Physical restraint use

Percentage of residents in daily physical restraints. (see data dictionary)

What do you think?

  • Looking at these results over time, are there any trends?
  • Looking at these results over time and between zones, are there differences?
  • After selecting a facility, are the site results changing over time? How do the most recent quarter results compare to the provincial and zone results?
  • When comparing sites with similarities like zone, setting (e.g., urban or rural), operator type (e.g., private), and size, how are the results different? What factors could account for these differences?

Whether you’re a resident, family member, provider, or health system administrator, thinking about why these differences might exist can start or inform conversations and lead to solutions for improved quality of healthcare.

Alberta Health Services, Analytics. “All 35 QIs by province/zone/facility”. (2019). [Dashboards showing RAI quality indicators, by province, zone, and site, by quarter]. AHS Tableau Reporting Platform. Retrieved from https://tableau.ahs.ca.

Understanding “physical restraint use”

This measure is a quality indicator (QI).

A physical restraint is a device that restricts a resident’s ability to move, and cannot be removed by the resident. At some long term care sites, physical restraints may be used in situations where the safety of the resident or others (e.g., other residents, family, or staff) is a concern.

Using physical restraints can be harmful to residents. Harmful effects include increased potential for falls that result in injury, as well as increased frustration and restlessness for the resident.

To deliver more person-centred care and balance the safety of the resident and others, most long term care sites have adopted a “least restraint” or “restraint as a last resort” policy. Some sites have a “no restraint” policy. The goal of these policies is to ensure all other non-restraint measures are considered and tried before the use of physical restraints.

The type of physical restraints included in this indicator include: seat belts, over chair tables, and bed restraints. The use of bed side rails as a restraint is not included in these results.

Considerations when viewing the results:

When thinking about this quality indicator, providers and leaders can consider a number of things to better understand and improve these results. Some questions they could ask before taking action include:

  • At sites with “least restraint” policies, what tools do staff have available to help assess and make appropriate decisions about when to use physical restraints?
  • How does the site or how can staff create a calm, safe environment for residents?
  • How might the resident, loved one(s), and staff work together to understand the underlying cause(s) of the need to physically restrain a resident? How are staff empowered to address the cause(s)?
  • How can staff be better educated to observe cues from the resident and change the environment or situation to prevent behaviours known to result in physical restraints?
  • Are there protocols in place to routinely review the use of physical restraints and remove physical restraints when no longer required?

The Health Quality Council of Alberta uses the Alberta Quality Matrix for Health as a way of organizing information and thinking around the complexity of the healthcare system. This measure can be used as input to assess long term care’s performance in these dimensions of quality:
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Dimensions of Quality

  • Acceptability 
  • Accessibility 
  • Appropriateness 
  • Effectiveness 
  • Efficiency 
  • Safety