Technical information about the physical restraint quality measure.

September 20, 2009 by admin

Older people can suffer from diseases of the brain, which causes them at times to behave in abnormal ways. Some residents of nursing homes have very abnormal or disturbing behavior such as hitting, spitting, wandering, or falling down frequently. In the past, the staff of the nursing home sometimes used physical restraints to prevent the resident from injuring themselves or other people, to keep them in bed, or to prevent them from falling. Current research in nursing homes has shown that in many cases, a careful assessment of the resident's behavior and risk factors can show the nursing home team ways to try to keep the resident safe without using physical restraints. Alternates to restraints are important to maintain the resident's strength and to ensure as much independence as possible. This type of treatment is not easy, and sometimes requires special training. Sometimes, even with the most advanced training and the best attempts to avoid using restraints, some use of physical restraints might be unavoidable. However, the use of the restraint must be strictly limited to those cases in which it is required to treat the resident's medical symptoms and it must be ordered by a physician. Other treatments must eventually be found so that the resident can be comfortable and safe without the need for physical restraints every day. Federal regulations state that a nursing home 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. Many scientific studies show that the use of restraints in nursing homes is no longer necessary with today's ability to diagnose and treat residents. While it is unlikely that the use of physical restraints in nursing homes will completely stop, CMS believes the percentage of residents in physical restraints can be significantly reduced with education and training of nursing home physicians and staff as well as residents and their families. Many nursing homes around the country have already accomplished this. We are committed to help all nursing homes achieve this goal. as Note: While bed rails, when used as a restraint, are not included in the calculation of this quality measure, CMS continues to identify them as a restraint. According to the MDS manual, physical restraints are 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. Full Bed Rails may be one or more rails along both sides of the resident's bed that block three-quarters to the whole length of the mattress from top to bottom. This definition also includes beds with one side placed against the wall (prohibiting the resident from entering and exiting on that side) and the other side blocked by a full bed rail. Included in this category are "veil" screens (used in pediatric units) and enclosed bed systems.