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Alternatives to Chemical Restraints in the Long Term Care Setting, Part I

This two part series will challenge perceptions about alternatives to chemical restraints in the long term care setting for residents with Alzheimer’s or other types of dementia. 

There are four basic keys to utilizing alternatives to chemical restraints with this unique population.  Understanding,  Communication, Attitude, and Willingness.  Each area needs to be addressed to achieve successful outcomes.


Understanding, is critical:  understanding the diagnosis that increases the potential for adverse, agitated, even combative behavior; understanding role delineation with nursing and therapy regarding chemical restraint reduction; understanding the triggers for the behavior; understanding that behavior is a form of communication often times resulting from an unmet need;  understanding adverse behavior occurs when the demand on a person exceeds the person's ability at any given time; understanding the importance of resident centered approach strategies.


Communication can be the basis for implementing resident specific approach strategies.  Communication is as important among direct care staff, nursing, dietary, therapy, physician, social services, and other departments, as it is with the resident and family members.  Communication is effective when each member of the interdisciplinary treatment team has the opportunity to provide feedback throughout the entire day.  This resident centered care approach empowers all staff to take ownership and share  strategies to decrease the risk of adverse behavior.


Attitudes can negatively, as well as positively, affect the work place.  "When people look at the past, they feel regret.  When they look at the future, they feel anxiety and pessimism.  In the moment they're bound to find something unsatisfactory.  They are suffering from automatic negative thoughts, ANTS, which are cynical, glooming, and complaining thoughts    A "Can-do", positive attitude is critical to the success of any organization, effecting all departments.


Willingness is the key to changing our understanding of resident specific triggers. Willingness is the key to always challenging, while striving to improve our understanding of residents entrusted to our care.  Willingness helps to improve our communication with each other, with our residents, families.   Willingness ties to ongoing staff training and trying new approaches including interdisciplinary treatment team regular weekly meetings. This treatment team may consist of the medical director, consultant,  pharmacist, director of nursing, unit nurse manager, MDS nurse, social services and therapy representative.

The focus of this team is to review each dementia resident on antipsychotic medications to determine if the need still exists. Resident concerns and adverse drug reactions - negative side effects should be discussed, along with recommendations to reduce or discontinue the use of psychotropic drugs, while ensuring that each psychotropic drug used has a specific diagnosis linked to it. 

While psychotropic medications can decrease the need for physical restraints, they aren't the only or necessarily the first treatment strategy. It is effective to incorporate intervention strategies including therapy, effective communication, environmental modifications to manage the behavior, instead of medicating the behavior to fit in the environment.  Look to identify the cause of the behavior, first, and then determining how to proceed.

--You have it easily in your power today, to increase the sum total of this world happiness, now.  How, by sharing a few words of sincere appreciation, to someone who is lonely or discouraged.  Perhaps tomorrow, you will have forgotten the kind words you said today, but the recipient will cherish them for a lifetime."   Dale Carnegie.

--You CAN make a difference in the care and life of the person with dementia!

Article by Tom Conrad, OTA/L, is a Clinical specialist for Cognition and Behavioral Approach strategies for HealthPRO Rehabilitation. In addition to providing daily treatment for clients with dementia and other psychiatric disorders, he develops and delivers continuing education seminars nationwide.


Tags: nursing home operations, nursing home occupancy, skilled nursing facility