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Reduction of Belt Restraint Use: Long-Term Effects of the EXBELT Intervention

Authors

  • Math J. M. Gulpers MSN, RN,

    Corresponding author
    • Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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  • Michel H. C. Bleijlevens PhD,

    1. Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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  • Ton Ambergen PhD,

    1. Department of Methodology and Statistics, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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  • Elizabeth Capezuti PhD,

    1. College of Nursing, New York University, New York, New York
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  • Erik van Rossum PhD,

    1. Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
    2. Research Centre on Autonomy and Participation, Zuyd University of Applied Sciences, Heerlen, The Netherlands
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  • Jan P. H. Hamers PhD, RN

    1. Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
    2. College of Nursing, New York University, New York, New York
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Address correspondence to Math Gulpers, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands.E-mail: m.gulpers@maastrichtuniversity.nl

Abstract

Objectives

To assess the long-term effects of the EXBELT intervention program, which was designed to reduce belt restraint use and was found to be effective immediately after implementation, after 24 months.

Design

Quasi-experimental longitudinal design.

Setting

Thirteen nursing homes: seven assigned to control group and six to intervention group.

Participants

A panel group (n = 225) of residents present at baseline and 24 months after baseline and a survey group (n = 689) of all residents present 24 months after baseline. The survey group included the panel group.

Intervention

EXBELT included four components: a policy change, an educational program, consultation, and availability of alternative interventions.

Measurements

The use of belt restraints 24 months after baseline was the primary outcome measure. Secondary outcomes included other types of physical restraints. An independent observer collected data four times during a 24-hour period.

Results

EXBELT resulted in a 65% decrease in belt use between baseline and 24 months after baseline in the panel group (odds ratio 0.35, 95% confidence interval = 0.13–0.93; P = .04). In the survey group, the proportion of residents using belts was 13% in the control and 3% in the intervention group (P < .001) 24 months after baseline. The use of the most restrictive types of restraints was significantly lower in the intervention group than the control group in the panel and survey groups.

Conclusion

The EXBELT intervention was associated with long-term minimization of belt restraint usage in older nursing home residents. A multicomponent intervention including institutional policy change, education, consultation, and the availability of alternative interventions had an enduring effect on successful restraint reduction.

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