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That's exactly where the surveyor is coming
from. The nurse on the unit said that whenever they have tried him at the
table without the tray, he slides out. I didn't think of trying it with the
surveyor there. I have asked our Rehab manager to eval him for
alternatives. He has been reassessed at least yearly for the tray, and it
is care planned. The table is new, and was initiated to try to put some room
between him and the other residents, who objected to him swinging and grabbing
at them. (Picky, picky, I know, lol)
Thanks for the idea.
----- Original Message -----
Sent: Wednesday, December 03, 2003 12:06
PM
Subject: RE: Restraints? Survey question,
of course
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
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-----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
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?
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