Harmony Healthcare Blog

Positioning Devices, Self-Releasing Devices and Restraints

Posted by Kathy Monahan on Thu, Mar 08, 2018


Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


Elderly patient looking at a nurse in hospital ward-199987-edited.jpegThe primary goal of therapeutic intervention when utilizing any therapeutic device or modality is to increase functional independence, improve functional abilities and enhance mobility utilizing the least restrictive intervention.

1.  Positioning Device

Positioning Device Purpose

Therapeutic use of positioning devices assists with, but is not limited to:

  • Maintaining independence with functional activities and mobility
  • Proper body alignment
  • Postural impairments
  • Hemiparesis
  • Contracture Management
  • Skin Integrity

Types of positioning devices include, but are not limited to:

  • Clip Belts
  • Half Lap Trays
  • Full Lap Trays
  • Arm Troughs
  • Leg Rests
  • Specialty Wheelchair Cushions (wedge, pommel, Jay, ROHO)
  • Lap Buddies

Patients who require a positioning device are not able to maintain upright posture in their wheelchair and will slide forward, slump over, lean forward, lean over armrests, or lean over the back of the wheelchair. 

Positioning Device Procedure

  • A licensed therapist will assess patients for appropriate interventions and a plan of care will be developed.
    1. The plan of care and treatment goals will be developed incorporating functional limitations as outlined in the initial evaluation.
    2. Therapist will provide documentation depicting the selected modality meets the needs of the patient.
    3. Therapy will in-service caregivers on the application and maintenance of the modality being implemented.
    4. Caregivers will demonstrate competency with the device by attending the in-services and completing a return demonstration of the use of the device as needed.
    5. After three consecutive treatment days with the positioning device/restraint:
      • Rehabilitation and Nursing will complete the Assessment for the Use of Therapeutic Devices form, or similar facility form.
      • A Physician’s Order for the positioning device being used and its potential benefit will be in the patient’s chart.
      • The specific device, its purpose and wearing schedule as indicated will be added to the patient’s care plan (ADL, Mobility, Falls, etc.).
      • Rehabilitation will complete a Positioning Profile for chair or bed.
      • Rehabilitation will maintain an updated list of residents utilizing all devices.
      • If the device is a Restraint, a Consent Form will be initiated, completed and signed.
    6. The need for the positioning device will be routinely reviewed and documented.

Positioning Device Documentation Examples

Pelvic Clip Belt as a Positioning Device

Assessment for Use of Therapeutic Devices form (or similar facility form) would read:

  • Patient to utilize pelvic clip belt while in wheelchair to “prevent sacral sliding” or “to maintain even pelvic positioning and increase independence with wheelchair mobility.”

Telephone Order would read:

  • Patient to utilize pelvic clip belt while in wheelchair, to prevent sacral sliding (or maintain even pelvic positioning and increase independence with wheelchair mobility).

Care Plan would read:

  • Patient to utilize pelvic clip belt while in wheelchair, to prevent sacral sliding and increase independence with wheelchair mobility.
  • Device should be snug across the groin area, with room for one finger. More than that puts the patient at risk to sacral slide. 

Lap Buddy as a Positioning Device

Assessment for Use of Therapeutic Devices form (or similar facility form) would read:

  • Patient to utilize lap buddy while in wheelchair, to maintain upright posture for increased independence with mobility and/or functional activity.

Telephone Order would read:

  • Patient to utilize lap buddy while in wheelchair, to maintain upright posture (or to prevent forward leaning) for increased independence with mobility and/or functional activity.

Care Plan would read:

  • Patient to utilize lap buddy while in wheelchair, to maintain upright posture for increased independence with mobility and/or functional activity. May remove while seated in front of hard surface (such as a table) with upper extremity support for increased independence with functional and/or midline activities. 

Full or Half Lap Trays as a Positioning Device

Assessment for Use of Therapeutic Devices form would read:

  • Patient to utilize full lap tray secondary to poor trunk control; or forward/side leaning; or for upper extremity support while in wheelchair to increase independence with wheelchair mobility and/or to increase independence with functional and/or midline activities.

Telephone Order would read:

  • Patient to utilize full lap tray secondary to poor trunk control; or forward leaning; or for upper extremity support while in wheelchair to increase independence with wheelchair mobility and/or to increase independence with functional and/or midline activities.

Care Plan would read:

  • Patient to utilize full lap tray secondary to poor trunk control’ or forward leaning; or for upper extremity support while in wheelchair to increase independence with wheelchair mobility and/or to increase independence with functional and/or midline activities. May remove while seated in front of hard surface (such as a table) with upper extremity support for increased independence with functional/midline activities.

Self-Releasing and/or Alarming Seatbelts as a Positioning Device

Assessment for Use of Therapeutic Devices form would read:

  • Patient to utilize self-releasing alarming seatbelt to be used as an auditory cue for patient and/or caregivers that assistance is needed with functional mobility.

Telephone Order would read:

  • Patient to utilize self-releasing alarming seatbelt to be used as an auditory cue for patient and/or caregivers that assistance is needed with functional mobility.
  • Check ability to self-release weekly (every Monday, Tuesday, etc.)

Care Plan would read:

Patient to utilize self-releasing alarming seatbelt to be used as an auditory cue for patient and/or caregivers that assistance is needed with functional mobility. 

Download the Positioning Devices, Self-Releasing Devices and Restraints  Assessment

2.  Self-Releasing and/or Alarming Devices

Self-Releasing and/or Alarming Devices Purpose

Therapeutic uses of self-releasing and/or alarming devices assist with but are not limited to providing auditory cues for patients and/or caregivers to alert them of self-rising attempts. 

Types of self-releasing and/or alarming devices include:

  • Velcro alarm belt: Use to remind patients and staff that the patient requires assist with self-rising, transfers and mobility. 
  • Pelvic clip belt (with and without alarm). Use to remind patients and staff that the patient requires assist with self-rising, transfers and mobility. 
  • Lap buddy with alarm.
  • Flip-up half and full wheelchair trays.
  • Self-releasing alarming lap buddy: Used in a wheelchair, alarming lap buddies are typically used as an auditory reminder for residents and staff that the patient requires assistance with self-rising, transfers and mobility.  It also provides trunk stability, upper extremity support for increased independence with functional activity. 

Self-releasing alarming devices are to be used only when the patient is able to remove the device; if the patient is unable to release this device, it may be considered a restraint. 

3.  Restraints

Restraints Purpose

Therapeutic use of a device used as a restraint may be used when all other interventions or alternatives to a restraint are not effective.  Restraints prevent the patient from rising on their own. 

Per the State Operations Manual, Appendix PP, a physical restraint is 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." (SOM, Section 483.13(a))

The State Operations Manual (SOM) further states that:

"The resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident’s medical symptoms.”

Types of Restraints

  • Lab buddy
  • Pelvic clip belt
  • Posey soft belt
  • Specialty cushion (Pommel, anti-thrust,)
  • Geri chair with lap tray

When considering a positioning device or restraint, we have to consider the effect of the device.  A lap buddy can be used as a positioning device when the patient is unable to maintain upright position in the chair and is used to provide trunk and upper arm/body support for wheelchair mobility or self-feeding.  It can also be used as a restraint to prevent a patient from rising from the wheelchair.  A pelvic clip belt is applied as a restraint to a patient.  The patient cannot unclip the belt upon command.  However, the patient plays with the belt, unclips it and is able to stand.  It is still considered a restraint as the patient is unable to follow commands consistently to unclip the belt. 

**Note:  The self-releasing alarming seat belt should not be used as a positioning device, nor should it be used solely as an auditory cue for staff.  Remember the intent and effect**

Procedure for Issuing a Restraint

In addition to the Assessment for Use of Therapeutic Devices or similar facility form, there are two additional forms used with restraints. 

  • Consent Form: Identifies that the device is determined to be a restraint.  Risks and recommendations for a specific device are explained on the form.  Authorization is given by the patient and/or responsible party and all sign the form.  A witness (typically a nurse) will also sign and date the form.  Verbal consent may also be given. 
  • Quarterly Restraint Review: Assessment done by the nurse to determine if the device continues to be appropriate for the patient. 

Documentation Examples Positioning Device

Pelvic Clip Belt as a Restraint

Assessment for Use of Therapeutic Devices form would read:

  • Patient to utilize pelvic clip belt to prevent self-rising due to: (poor standing tolerance; gait disturbances; poor balance; decreased safety awareness) secondary to DJD; OCD; OA; Dementia.

Telephone Order would read:

  • Patient to utilize pelvic clip belt to prevent self-rising due to: (poor standing tolerance; gait disturbances; poor balance; decreased safety awareness) secondary to DJD; OCD; OA; Dementia.

Care Plan would read:

  • Patient to utilize pelvic clip belt to prevent self-rising due to: (poor standing tolerance; gait disturbances; poor balance; decreased safety awareness) secondary to DJD; OCD; OA; Dementia.
  • May release as needed for repositioning, during mealtime, or while seated in front of hard surface with upper extremity support for increased independence with functional and/or midline activities.

Consent Form:

  • Patient to utilize pelvic clip belt to prevent self-rising due to: (poor standing tolerance; gait disturbances; poor balance; decreased safety awareness) secondary to DJD; OCD; OA; Dementia.

Restraint Review:

  • Initiated within 90 days of date that the device was issued.

Lap Buddy as a Restraint

Assessment for Use of Therapeutic Devices form would read:

  • Patient to use Lap Buddy to prevent self-rising due to: (poor standing tolerance; gait disturbances; poor balance; decreased safety awareness) secondary to DJD; OCD; OA; Dementia.

Telephone Order would read:

  • Patient to use Lap Buddy to prevent self-rising due to: (poor standing tolerance; gait disturbances; poor balance; decreased safety awareness) secondary to DJD; OCD; OA; Dementia.

Care Plan would read:

  • Patient to use Lap Buddy to prevent self-rising due to: (poor standing tolerance; gait disturbances; poor balance; decreased safety awareness) secondary to DJD; OCD; OA; Dementia.
  • May release as needed for repositioning, during mealtime, or while seated in front of hard surface with upper extremity support for increased independence with functional and/or midline activities.

Consent Form:

  • Patient to use Lap Buddy to prevent self-rising due to: (poor standing tolerance; gait disturbances; poor balance; decreased safety awareness) secondary to DJD; OCD; OA; Dementia.

Restraint Review:

  • Initiated within 90 days of date that the device was issued.

**When issuing a different device, all previous forms should be removed from chart and replaced with updated forms. **

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have. You can 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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