The use of physical restraints in long-term care facilities within Northern Health is three times higher than the national average, according to the Canadian Institute for Health Information (CIHI).
Restraints include bed rails, chairs that prevent people from rising, as well as trunk and limb restraints. These restraints are sometimes used to manage behaviours or to prevent falls.
According to CIHI, there are many potential physical and psychological risks associated with applying physical restraints to older adults, and such use raises concerns about safety and quality of care.
Although the percentage of physical restraint use in Northern Health facilities has been declining over the past few years – from 29.7 per cent in 2011/12 to 24 per cent in 2015/16 – it still sits well above B.C.’s average of 9.6 per cent and the national average of 7.4 per cent.
The Pines, the only long-term care facility operated by Northern Health in Burns Lake, had a staggering 34.4 per cent of its residents in daily physical restraints in 2012/13. That percentage has been steadily declining over the past few years, however, and now sits at 1.3 per cent.
Andrea Palmer, a spokesperson for Northern Health, said the decrease in reported restraint use at The Pines is partially related to a reduction in the use of restraints, but primarily attributable to education about how to accurately report what a restraint is.
For example, if a patient does not have the physical ability or cognitive capacity to rise from any chair, and that person is placed on a chair that prevents he or she from rising, this should not be reported as restraint use. However, if the patient has the ability to rise from a non-restricting chair, and this person is placed on a chair that prevents he or she from rising, then this should be reported as restraint use.
Palmer said Northern Health has had “inaccuracies” with regard to the data provided to CIHI.
“What’s come out is that well-intended staff have been coding restraints that are not actually considered a restraint,” she said. “We’re working on cleaning up those [data] quality issues, making sure that staff is trained particularly around coding and reporting.”
In addition to targeted training for staff, Northern Health has implemented a ‘community of practice’ composed of representatives from all the long-term care facilities to share best practices regarding restraint use, data coding and other residential care practices.
Northern Health has also recently implemented a regular quarterly review of their restraint use so that concerns and issues can be monitored and addressed.
“When we talk about restraining, it can be really alarming for people to hear that word,” said Palmer. “Restraint means something different in long-term care than it does in acute care; our restraint is a bed rail, or a chair that prevents someone from getting up.”
“We would never just cage someone in their beds,” she added. “If they needed to be restrained or kept safe overnight with bed rails, it would involve a physician recommendation, or a conversation with the family.”