You are right in that a restraint can only be used when medically necessary. Documantation is the key. Document EVERYTHING that has been tried prior to using the restraint, and start with the least restrictive device first. If is does not work, then go to something more restrictive. As far as consents go, I believe that the RP has to agree once the risks vs benefits are explained. If the RP does not agree, I don't see as where you have a choice but to dischgarge the resident as the facility cannot meet his needs. Another facility might be able to meet his needs without restraints, OR once the RP realizes that the family member is going to discharged they might change their minds and sign the consent. AS far as how often to reassess, I'd do it everytime I do an MDS (@ least quarterly, if not PPS. I'd also document it throughly everytime its reassed. Hopefuly the family is coming to Careplans where the need for continued use of the restraint can be discussed.
-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Jennifer Russo Sent: Friday, October 31, 2003 3:24 PM To: [EMAIL PROTECTED] Org Subject: Rena? Deb Ohl? Guru's? "Informed consent" for restraint - kinda long but I need advise!! I am getting several different points of view on the use of and need for informed consents with the use of a physical restraint that was assessed to be medically necessary to treat a medical symptom by the interdisciplinary team. We have mock surveys at our sister facilities in the area. One of the administrators said that families cannot dictate use of a restraint and we do not need their permission to restraint if it is properly used to treat a medical symptom. The other administrator says the informed consent is still needed. Our consultant said that we are getting mixed up in the terminology. She said that the families / Responsible parties have to be notified of the use of the restraint, medical reason, risks of uses, risks of non uses, but they do not have to "give us permission". My understanding of the F tag and guidance to the surveyors is that the responsible party cannot tell us to restrain a person without just cause (i.e. discipline, convenience or no medical symptom) but the guide is not clear about the right to refuse the treatment. If they refuse the restraint and we have tried everything else, then what do we do? Tell the family that we cannot provide the care their loved one requires... How often do you review restraint use with MD and family? Right now we review quarterly for reduction but MD and family are only notified when it is initiated and when a reduction is planned. Sorry for being so wordy!!!!! Thanks in advance to whoever was brave and read this!! /---------------------------------------------------------- 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 -----------------------------------------------------------/ /---------------------------------------------------------- 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 -----------------------------------------------------------/
