In the Saskatoon Health Region, data has been credited with helping to turn a philosophical shift into practical changes on the front lines of care.
Although a least restraint use policy had been introduced in 2004, quality indicators showed that at Pleasant View Care Home in Wadena, Saskatchewan, more than 50% of residents were being physically restrained on a daily basis in 2005. Facility manager Dayle Maryniak remembers being taken aback.
“It was terrible,” she says. “The restraints weren’t ever meanness on the part of staff. It was their attempt to keep their clients safe. But because you get used to looking at the people you care for every day, until numbers indicate to you what is actually happening and you stop and look, it was just the business we did every day.”
The indicators were developed by interRAI, an international research collaborative, and supported for use in Canada by CIHI. They allowed Maryniak to assess individual residents and compare her nursing home to other long-term care facilities.
The indicators also showed that while some homes were doing well, nearly half of all nursing homes in the region were exceeding the daily restraint use threshold of 8.7% of residents. A decade ago, anyone prone to fall or wander was restrained. But a shift in care approaches meant that was no longer acceptable. With so many risks associated with restraints, Sherri Solar, Supportive Care Projects Coordinator for the region, says they worked to ensure that people looked at all alternatives before using them.
“We took two individual clients to start with and asked ourselves, ‘If we take away the restraints, what options are there?’” Maryniak recalls. “That started a whole journey of education and interaction with staff and clients to apply that to other residents.”
Restraint use has dropped 20% across the region and 40% at Pleasant View, despite an increase in dementia and frailty cases among residents. Today, use is short term and never a unilateral decision. Care teams and family members are involved.
“It’s phenomenal. Culture change is happening,” says Solar. “But I don’t think we could have done this without looking at the data.”
Maryniak says while residents are visibly happier, the lack of screaming and anguished noises, as well as staff complaints of bites, punches and kicks, which were commonplace even six years ago, has driven home what they’ve accomplished.
“It’s been a worthwhile journey. Staff and clients have benefited immensely from it.”
More information on interRAI indicators.