Harmony Healthcare Blog

Physical Restraints: Proper Evaluation and Implementation (Part 2)

Posted by The Harmony Team on Tue, Aug 16, 2016


Edited by Kris Mastrangelo

C.A.R.E.

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


PHYSICAL_RESTRAINT.jpgWhat are the devices currently used by your facility for fall prevention strategies? Do you use crisscross belts or a low bed? Are these devices properly assessed for each resident and appropriately identified as a restraint when the use meets the regulatory definition?  This line of questioning will aide in narrowing down the focus areas necessary for the historic as well as the newly implemented Quality Measures. In addition, this systematic inquisition will dissect triggers that could misrepresent the care planning efforts of the clinical team. 

As such, facilities strive to reduce and eliminate the use of restraints as much as possible.  Restraints impede the patient's ability to function independently and may also cause isolation and other psycho-social issues

It is important that facilities identify any devices that could hold down a patient.  When a restraining device is identified, the facility must immediately begin planning for patient safety as well as for reduction or elimination of the restraint.

Developing a Restraint Assessment and Care Plan: 

Before the facility uses a restraint, they must initiate a Restraint Assessment and create a Care Plan summarizing the findings and efforts for restraint alleviation and discontinuation. 

  • The Restraint Assessment should include ample information to design individualized Care Plan interventions that will minimize or eliminate the clinical symptom/manifestation(s) that are causing the need for the restraint. 
  • Any underlying medical causes for the  clinical symptom/manifestation must also be considered when developing individualized Cape Plan interventions. 
  • Risks related to restraint use should be identified and the Care Plan that results from this assessment should include tactics to reduce or eliminate the restraint as soon as possible. 
  • The Care Plan should clearly show when the restraint is to be applied and released, and daily documentation should support that the Care Plan was followed.

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Survey Process of Physical Restraints: 

Surveyors are instructed to determine if the restraint being used is for a medical cause or clinical symptom/manifestation and then to evaluate if the medical record clearly demonstrates a clear and detailed understanding of the root causes for the restraint use with exhaustion of other unsuccessful interventions.  The surveyor will determine if the facility has properly assessed the patient by determining the following: 

  • If the facility attempted another alternative; such as rehabilitative/restorative care, or meaningful diversion activities,
  • If the facility made an effort to prevent an avoidable decline that was caused by the use of the restraint,
  • If the patient or patient representative is informed of the risk/benefit of the use of a restraint as well as the possible, negative outcomes associated with restraint use. 
  • Finally, the surveyor will determine if the facility completed an assessment to see if restraint reduction and/or elimination are appropriate or attempted.  

In order to be compliant with restraint use, the device must meet the following criteria: 

  • Must be necessary to treat a medical cause and/or clinical symptom/manifestation;
  • Must not be used to discipline a resident or for staff convenience in the absence of a medical symptom;
  • Must be the least restrictive device possible, in use for the least amount of time per day possible; and
  • The facility must have an active plan in place to decrease usage or for eventual removal of the restraint. 

Surveyors are instructed to review restraint use while they complete their annual survey.  If a surveyor notes a device being used that appears that it could meet the definition of a restraint, the surveyor will begin to investigate the use of that device to determine if the device is in compliance with regulations. 

The Critical Elements Pathway for restraint use states: 

“Do not rely on facility documentation alone to determine whether the device or practice is a restraint. It is a surveyor's determination whether the device or practice is restraining the resident, despite facility documentation to the contrary. If facility records state that the device (or practice) is not a restraint, but the surveyor’s investigation finds otherwise, the device or practice is a restraint.” 

Harmony Healthcare International (HHI) recommends a 5 Point Plan to follow when exploring the use of restraining devices. 

  1. Any device that has the potential to function as a restraining device requires careful review.
  2. Facility protocol must require the completion of a Restraint Assessment in order to formally evaluate and determine if the device is restraining the patient. 
  3. The results of the Restraint Assessment should be incorporated into the resident specific Care Plan.  This individualized plan must address the use of the device, and specify if the device is considered a restraint for that patient. 
  4. The Care Plan should address any risks that the device poses for the patient, combined with the facility plan to reduce or mitigate those risks.  
  5. The Care Plan should describe the plan for gradual restraint reduction and/or reasons why prior attempts have been unsuccessful.

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.   You can read Part 1 of the Physical Restraint Series by clicking here.


 
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Tags: physical restraints

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