Am writing from northeast Florida. Had our survey last week. No quality of care
issues. We got 5 D s/s tags. Now it is time, of course, to do plan of correction.
The surveyors hit HARD on restortative program and focused in on toileting. Also,
ROM. ROM with a.m.and h.s. care was deemed not to be sufficient to make sure that the
resident maintained their highest practical level. Said nurses were exceeding their
scope of practice by recommending restortative nursing and that anyone who had
restortative nursing must have recommendation from therapy. Also, only therapy could
screen for and recommend any type of restraint or positioning device.
We have 15 persons with bed and/or chair alarms (in facility of 60) and they said our
facility was entirely too quiet. That alarms should be going off and responded to all
of the time. Said lap buddys were obsolete.
Restraints section of MDS was one that was always discussed at length at care plan
meeting. Restraint/Physical Device Assessment was done by nurses. If resident had on
restraint of any type and could remove it it was clear cut "no restraint". If
resident was alert and could not remove restraint then it was clear cut "restraint".
Ones that provoked most discussion were those residents who had severe cognitive
impairment, who didn't know restraint/positioning device was there and who couldn't
remove it. For example, person with end staage dementia who had lap buddy to keep her
from falling face forward onto the floor out of her wheelchair. Since she could not
get out of the w/c if she wanted to (which she didn't), since she didn't attempt to
remove lap buddy, nurses coded her as using lap buddy as positioning device.
According to state inspectors, there is only one criteria for restraint and that is
"if the resident cannot remove on command, it is a restraint". comments please.
/----------------------------------------------------------
The Case Mix Discussion Group is a free service of the
American Association of Nurse Assessment Coordinators
"Committed to the Assessment Professional"
Be sure to visit the AANAC website. Accurate answers to your
questions posted to NAC News and FAQs.
For more info visit us at http://www.aanac.org
-----------------------------------------------------------/
