Missouri QIO Drives Decline in Use of Restraints in Nursing Home

Working with Primaris, Missouri’s Quality Improvement Organization (QIO) through July 2014*, a 60-bed nursing home in Southwest Missouri reduced the use of restraints among its residents from 28.9 percent to 2.3 percent in just over a year (2012-2013).

Once seen as tools to help prevent nursing home residents from injuring themselves, restraints are now recognized as presenting serious health risks to residents, contributing to circulation problems and pressure ulcers. Primaris collaborated with nursing homes to reduce restraint use, leading to improved quality of life and health among residents.

Using Primaris data reports compared to data collected from clinical assessments of patients, restraint count inconsistencies were identified. For example, some residents were being counted as restrained when fastening their wheelchair seatbelts as the resident’s own security measure.

Primaris helped Cassville Health Care & Rehab in Cassville, Mo. develop alternatives to restraint use, starting with using the Primaris’ Restraint Reduction toolkit and conducting staff education.

Cassville Health Care & Rehab used different equipment and expanded care planning to include therapy, activities staff and other nursing staff to devise ways to reduce restraints. Nursing home staff also reached out to residents’ families to discuss any reservations about removing restraints utilizing the Primaris patient and family brochure that provides education about the hazards of restraint use.

When Primaris began working with Cassville Health Care & Rehab, the nursing home had the highest restraint use in the state. Since working with Primaris, the home has maintained a restraint rate at near or below the Missouri state average of 2 percent.

The positive impact on residents’ quality of life has, in turn, improved employee morale. Nursing home leadership to certified nursing assistants, and families and community members are all pleased with these changes. The staff at the facility remains committed to sustaining their low average while striving for zero restraints.

*In spring of 2014, CMS determined to separate the consumer type protection activities - case review, beneficiary complaint and appeals - from the quality improvement work for the QIO program going forward.  As of August 1, Missouri is represented by two Quality Improvement Organizations. Beneficiary and family centered care services are now provided by KEPRO. Primaris in Missouri has joined TMF Health Quality Institute to form the TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO) to provide quality improvement work in Missouri.