Harmony Healthcare Blog

Physical Restraints: Defined and Refined (Part 1)

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Thu, Aug 11, 2016

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Edited by Kris Mastrangelo


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

restraint.jpgIn 2012, I was hired to evaluate the clinical and operational aspects of a nursing facility in another country.  I was excited to escape the red tape and mountains of regulations connected to care in the United States.  In fact, the best part of this engagement (I thought) was that the rules and policies in this country for operating a nursing home for the elderly to reside were comprised of a mere 18 pages

Then, within 20 minutes of touring the facility, I wished I was back in the states.  Why did I experience the blood rushing from my head to my toes with a feeling of dizziness?  Because every resident was in a restraint!  As you know, I am an Occupational Therapist.  I am an avid believer that movement cures all.  I restrained myself (no pun intended) from berating the staff for their ignorance. 

That’s when I experienced a flash back to 1992 during my initial days in a U.S. Nursing Home.  We too had this misunderstanding that restraints were helpful and kept the residents safe. What did the U.S. learn that this other country needed to know? 

Physical restraints are associated with many negative outcomes, including, but not limited to: 

  1. Injury
  1. Inhibited Movement
  1. Poor Circulation
  1. Constipation 
  1. Incontinence 
  1. Decrease Strength 
  1. Decreased Bone Density 
  1. Increase Pressure Ulcers 
  1. Decease Appetite 
  1. Increased Infections 

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Now that we have established that restraints are not the best methodology for caring for residents, let’s better define WHAT constitutes a restraint.  

Per the State Operations Manual (SOM), 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.” 
  • “A device is not defined as a restraint because of the type of device that it is, but rather based on the effect of the device upon the resident.  The same device may have the effect of restraining one individual but not another, depending on the individual resident’s condition and circumstances. “ 

As one can see, the restraint “decision tree” takes thought and team process.  One of the most frequent questions posed to our Harmony HealthCARE Specialists is “How does a facility properly evaluate and implement restraint usage?” 

Stay tuned for Part II of our Physical Restraint series, as Elisa Bovee, Senior VP Operations, and Melissa Fox, Senior HealthCARE Specialist, answer these remaining questions.

 If you have questions or concerns about physical restraints, please contact Harmony Healthcare International by clicking here or calling our office at 1.800.530.4413. 

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