Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency
The Physical Restraint Quality Measure is common on for error and miscoding. This measure reports the percent of long-stay nursing facility residents who are physically restrained on a daily basis. Nursing facilities consistently strive to reduce unnecessary physical restraints and safeguard that residents are free of restraints unless deemed necessary and appropriate. Even though this is a continuous are of focus, it is beneficial for you and your staff to review the definition and intent of physical restraints.
- Know the Definition per RAI Manual
“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”.
- Define the Quality Measure Specifications
Long-stay residents with a selected target assessment that indicates daily physical restraints, where:
• trunk restraint used in bed (P0100B is coded ), OR
• limb restraint used in bed (P0100C is coded ), OR
• trunk restraint used in chair or out of bed (P0100E is coded ), OR
• limb restraint used in chair or out of bed (P0100F is coded ), OR
• chair prevents rising used in chair or out of bed (P0100G) is coded ).
All residents with a target assessment, except those with exclusions.
- Determine WHY a Restraint is Being Used
Prior to using any physical restraint, the nursing home must assess the resident to properly identify the resident’s needs and the medical symptom(s) that the restraint is being employed to address. If a physical restraint is needed to treat the resident’s medical symptom, the nursing home is responsible for assessing the appropriateness of that restraint. When the decision is made to use a physical restraint, CMS encourages, to the extent possible, gradual restraint reduction because there are many negative outcomes associated with restraint use.
While a restraint-free environment is not a federal requirement, the use of physical restraints should be the exception, not the rule.
- Know the Regulations
Federal regulations and CMS guidelines do not prohibit use of physical restraints in nursing homes, except when they are imposed for discipline or convenience and are not required to treat the resident’s medical symptoms. The regulation specifically states, “The resident has the right to be free from any physical or chemical restraints imposed for the purposes of discipline or convenience and not required to treat the resident’s medical symptoms” (42 CFR 483.13(a)).
- Research and Understand the Clinical Aspects of Restraint Use
Research and standards of practice show that physical restraints have many negative side effects and risks that far outweigh any benefit from their use. Prior to using any physical restraint, the nursing home must assess the resident to properly identify the resident’s needs and the medical symptom(s) that the restraint is being employed to address. If a physical restraint is needed to treat the resident’s medical symptom, the nursing home is responsible for assessing the appropriateness of that restraint. When the decision is made to use a physical restraint, the facility is encouraged, to the extent possible, gradual restraint reduction because there are many negative outcomes associated with restraint use.
Although the requirements describe the narrow instances when physical restraints may be used, growing evidence supports that physical restraints have a limited role in medical care. Physical restraints limit mobility and increase the risk for a number of adverse outcomes, such as functional decline, agitation, diminished sense of dignity, depression, and pressure ulcers.
Residents who are cognitively impaired are at a higher risk of entrapment and injury or death caused by physical restraints. It is vital that physical restraints used on this population be carefully considered and monitored. In many cases, the risk of using the physical restraint may be greater than the risk of it not being used.
The risk of restraint-related injury and death is significant when physical restraints are used. When the use of physical restraints is considered, thorough assessment of problems to be addressed by restraint use is necessary to determine reversible causes and contributing factors and to identify alternative methods of treating non-reversible issues.
Once you have completed the above, and determined that a physical restraint is the best option, there are 7 Steps for Assessment. Stay tuned for the follow-up to this blog post.
Harmony Healthcare International (HHI) is available to provide onsite analysis and associated medical record reviews to help you improve your Quality Measure Scores. Please contact Harmony Healthcare International by clicking here or calling our office at 1.800.530.4413.
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