RE: Restraints? Survey question, of course

[Brenda Chance]

I think where the survey team is coming from is the fact that he has a lap table in front of him and then is sitting up at a table.  If he is sitting up at the table, then potentially the lap tray could be removed.    I would explain to them about the lap tray being a positioning device.  Maybe sit him at the table (the 1st time without surveyors) with the lap tray on and see is he slides.  If he does, then you have won your battle.  Is your lap tray care planned for positioning?   Brenda W. Chance, RN, RAC-C MDS Coordinator     CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. -----Original Message----- From: Holly Sox, RN, RAC-C [mailto:[EMAIL PROTECTED] Sent: Wednesday, December 03, 2003 9:49 AM To: [EMAIL PROTECTED] Subject: Restraints? Survey question, of course   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]