"'Physical Restraints' are defined as any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body."
Both the RAI User's Manual and the Guidance to Surveyors provide further explanations of this definition.
Take each device separately and determine whether it meets the definition. If you determine that one or both of the devices do not meet the definition, I recommend that the facility explain its rationale to the surveyor. If the surveyor does not agree with your conclusions, your administrator might consider discussing it with the survey team's supervisor and/or your state RAI coordinator.
Here are the probes the surveyors use to evaluate devices that meet the definition of a restraint:
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Probes: �483.13(a)
This systematic approach should answer these questions:
1. What are the medical symptoms that led to the consideration of the use of restraints?
2. Are these symptoms caused by failure to:
a. Meet individual needs in accordance with the resident assessments including, but not limited to, section III of the MDS, Customary Daily Routines (MDS version 2.0 section AC), in the context of relevant information in sections I and II of the MDS (MDS version 2.0 sections AA and AB)?
b. Use rehabilitative/restorative care?
c. Provide meaningful activities?
d. Manipulate the resident's environment, including seating?
3. Can the cause(s) of the medical symptoms be eliminated or reduced?
4. If the cause(s) cannot be eliminated or reduced, then has the facility attempted to use alternatives in order to avoid a decline in physical functioning associated with restraint use? (See Physical Restraints Resident Assessment Protocol (RAP), paragraph I).
5. If alternatives have been tried and deemed unsuccessful, does the facility use the least restrictive restraint for the least amount of time? Does the facility monitor and adjust care to reduce the potential for negative outcomes while continually trying to find and use less restrictive alternatives?
6. Did the resident or legal surrogate make an informed choice about the use of restraints? Were risks, benefits, and alternatives explained?
7. Does the facility use the Physical Restraints RAP to evaluate the appropriateness of restraint use?
8. Has the facility re-evaluated the need for the restraint, made efforts to eliminate its use and maintained residents' strength and mobility?
>>
Rena
Subj: Restraints? Survey question, of course
Date: 12/3/2003 7:49:58 AM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
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]
