Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency
Usage of the Merry Walker Ambulation Device requires observation of a professionally trained medical person to determine if the device constitutes a restraint.
- The Merry Walker may not constitute a “restraint” if the patient is able to open, close and maneuver out of the front gate independently.
- The Merry Walker is considered a restraint if the patient is unable to open and close the front gate and caregiver assistance must be provided to release the resident form the device. These details must be documented in the medical record. It is prudent to obtain a physician’s order.
The RAI User’s Manual defines a physical restraint 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 (State Operations Manual, Appendix PP).
- When the interdisciplinary team determines that the use of physical restraints is the appropriate course of action, and there is a signed physician order that gives the medical symptom supporting the use of the restraint, the least restrictive manual method or physical or mechanical device, material or equipment that will meet the resident’s needs must be selected.
The “Merry Walker” name is no longer listed as a chair that prevents rising in the MDS Guidelines. The state surveyors diligently review whether a resident is properly assessed for usage of the Merry Walker.
Use of a Merry Walker may be very appropriate; however, the restraint issue arises if the resident cannot release and step out of the device.
The fact that the resident is capable of walking does not determine whether the Merry Walker is considered a restraint. The standard is that if he/she cannot open the device and step out safely, it is considered a restraint. The individual resident specific assessment will indicate that it is an appropriate use of a restraint to assist in function.
Per the RAI Manual
“Enclosed-frame wheeled walkers, with or without a posterior seat, and other devices like it should not automatically be classified as a physical restraint. These types of walkers are only classified as a physical restraint if the resident cannot exit the walker via opening a gate, bar, strap, latch, removing a tray, etc. When deemed a physical restraint, these walkers should be coded at P0100G–Chair Prevents Rising.”
If the individual assessment results in the determination that the device meets the definition of a restraint, the person-centered Care Plan should address how, when and why the device is used. The care plan musty also define the parameters for use and non-use (i.e. during meals, for toileting, when in supervised activities etc.).
Harmony Healthcare International (HHI) performs monthly compliance audits. If you need help with this area, please contact us by clicking here. Looking to train your staff? Join us in person at one of our our upcoming Competency/Certification Courses. Click here to see the dates and locations.
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