Restraints? Survey question, of course

[Holly Sox, RN, RAC-C]

Hi, Group! Survey team leader was asking about a resident with potentially double restraint.  I have not coded this resident as having a trunk restraint. He has virtually no voluntary movement in his lower extremities and very poor balance and safety awareness.  He has a lap tray when he is up in his chair, because otherwise he slides out.  It is not restricting any access to his body, at least not in my opinion.  He does flail his arms and hands at times, reaching and grabbing at others, and punches/hits at times.  He has an order for soft wrist restraints during care, which are used only if he is combative, and this is addressed and care planned.   The double restraint issue has sprung from a table that activities has set up for his use in the dining/activity area.  It is a half-circle table, that he is placed behind with a "busy box" of toys and things to play with.  He is able to reach and grab and play without the chance of harming others.  We still use the lap tray because the table does not prevent him from sliding out of the chair.   So, is there anyone (or more than one) out there who can give me some guidance on this?  He seems truly happy when he is up at the table, and is able to interact/socialize with other residents and staff safely.  I can't see removing the lap tray.  The lap tray alone is not enough of a barrier to keep him from hitting others.  If the lap tray is truly a restraint, then is there ever a situation where a double restraint is acceptable?  Is there any documentation of this?  Thanks!! Holly F. Sox, RN, RAC-C Clinical Editor, Careplans.com www.careplans.com    [EMAIL PROTECTED]