New Jersey success stories

NJ Local Success Stories
Quality improvement endeavors can often feel overwhelming, but chances are, you can learn from the experiences that another physician, hospital or nursing home has had in a similar situation. Coupled with support from Quality Insights Quality Innovation Network, learning what has worked for others — and what didn't — is a valuable strategic planning component. View local stories about the Everyone with Diabetes Counts (EDC) program


Teamwork and Diligence Reduces Restraints at Greenwood House

5/6/2016
Three years ago, Greenwood House in Trenton, NJ began the journey to reduce the use of physical restraints on its residents after learning its restraint rates were higher than they wanted them to be.
 
To jumpstart the process, the Nursing Rehabilitation Coordinator met with a Quality Improvement Specialist at Healthcare Quality Strategies, Inc. (HQSI), which is now a part of the Quality Insights Quality Innovation Network, to find an approach that would offer their residents more individualized care. The coordinator used tools and resources provided by her Quality Improvement Specialist and conducted additional research to help support her plan. The goal was to remove any unnecessary restraints on the residents and ensure care staff was practicing restraint alternatives.
 
With information, determination, and support, the coordinator identified 15 residents with whom she could perform a two-week, restraint-free trial.  After assessing the residents, staff removed restraints, and instituted monitoring with clip alarms and seat alarms.   As part of the trial, all staff, including maintenance and housekeeping received training on use of the alarms. Additionally, with buy-in from administration, Greenwood House hired two extra CNAs for the Dementia unit, reducing stress on the nursing home staff.
 
At first some nurses were concerned about this approach and reverted to using restraints.  To counter the concern staff received education that emphasized that the residents would be safer, happier, and more relaxed if restraint-free. The coordinator also reminded them that this was not optional and they had to work as a team to be successful.
 
The support system established between the coordinator, the staff nurses, and the CNAs helped the new care approach succeed. They continued, eventually completing their two-week restraint-free trial beyond the initial list of residents, into all areas of the facility, and even past 14 days.
 
Greenwood House now approaches new residents differently than before.  Staff try a variety of different methods to determine the resident's true needs, rather than relying on a restraint. As a result of education, tools, resources, teamwork, and providing support, Greenwood House's physical restraint rates plummeted. On top of that, their falls showed a relative improvement rate of 16% for the same 12-month period.
 
Greenwood House has successfully sustained the gain. To this day, they use this strategy and it is still proving to work for them. Greenwood House demonstrated person-centered care and worked together as a team to achieve success and hopes to be an example for other nursing homes.