TIP OF THE WEEK
Reducing restraints
Ohio nursing home restraint use is at six percent, a decrease of four percentage points since October 2002. We are on our way to achieving the national goal established by the Centers for Medicare & Medicaid Services of less than two percent.
Below are a few points to consider to further reduce the use of restraints in your home:
- Staff Attitudinal Survey. It is often beneficial to conduct a staff attitudinal survey regarding restraints and their use. This allows the restraint reduction team to know what concerns the staff restraint reduction or what benefits they feel restraints provide to the residents.
- Educate Staff, Residents, and Families. Use the results of the staff attitudinal survey to put together staff training. In addition to educating the staff, you must educate your residents and families on the reasons and advantages for restraint reduction. Keeping these individuals informed of your plan and progress can significantly improve the success of your restraint reduction program.
- Communicate with Physicians. It is important to inform physicians of any new program and goals.
- Set Goals and Track Improvements. It is important to keep your eye on the data to know whether or not you are making improvements. The Nursing Home STAR Web site,
www.nhqi-star.org, allows you to do just that. Once you set your goals on the Web site, you can print graphs that show your facility measures in comparison to state and national averages. Place these graphs in staff areas to keep these goals in the forefront of employees’ minds. - Start with Small Wins. Restraint reduction should be a gradual and well-planned process. Starting with some of the easiest restraints to reduce first helps staff members see progress early in the program. Small wins early tend to bolsters enthusiasm for the program.
- Assess and Reassess. Don’t forget, assessment and reassessment are key to safely and appropriately reducing the use of physical restraints.
Resources for restraint reduction:
- ODH Restraint Decision Tree. The “Guidelines for Restraint Use” decision tree provided by the Ohio Department of Health was revised in February 2007 and it is helpful in determining what devices are considered restraints. Reference this decision tree each time a physical restraint is being considered. Information is provided on assessing and reassessing the need for the restraint, resident choice and restraint use, and bed rails.
- Ohio KePRO Restraint Resource CD-ROM. This manual has all the tools needed for an effective restraint reduction program. Go to www.ohiokepro.com/shopping to order a copy at no charge.
- Audio Recording: Becoming Restraint Free. This previously recorded teleconference includes a panel discussion with representatives from restraint-free homes who talk about how they became and maintain a restraint-free home. Go to www.ohiokepro.com/shopping to order a copy at no charge.
- STAR Web site. Go to www.nhqi-star.org to set target goals and track your improvements.
RESOURCE SPOTLIGHT
MedQIC contains tools, literature, stories, and quality improvement strategies for reducing the use of physical restraints.
Reminder: The Centers for Medicare & Medicaid Services (CMS) has contracted with Westat to survey a sample of Ohio healthcare providers about Ohio KePRO, the Medicare Quality Improvement Organization (QIO) for Ohio. If contacted, please take the opportunity to complete this voluntary, confidential survey online or by phone and help shape the future of healthcare quality improvement in Ohio.
IN THE NEWS
Federal Register: CARE Tool for Uniform Patient Assessment Open for Comment
July 27, 2007 -- The Medicare Continuity Assessment Record and Evaluation (CARE) is a uniform patient assessment instrument designed to measure differences in patient severity, resource utilization, and outcomes for patients in acute and post-acute care settings.
This tool will be used to:
- Standardize program information on Medicare beneficiaries’ acuity at discharge from acute hospitals
- Document medical severity, functional status and other factors related to outcomes and resource utilization at admission, discharge, and interim times during post acute treatment
- Understand the relationship between severity of illness, functional status, social support factors, and resource utilization
This tool will be tested across the continuum including acute hospitals, long-term care hospitals, inpatient rehab facilities, skilled nursing facilities, and home health agencies. The Centers for Medicare & Medicaid Services (CMS) is currently accepting volunteers for this demonstration project. See the supporting documents for more information.
USE OF HIP PROTECTOR DOES NOT REDUCE RISK OF HIP FRACTURE FOR NURSING HOME RESIDENTS
July 24, 2007 -- Newswire -- Use of an energy-absorbing hip protector did not protect nursing home residents, adding to increasing evidence that hip protectors, as currently designed, are not effective according to a study in the July 25 issue of JAMA. Read more >>
THREE OHIO CITIES RANKED AMONG BEST METRO AREAS FOR SENIORS
August 2007 -- ODA Aging Connection -- Cincinnati ranked ninth, Cleveland was 11th and Columbus landed the 28th spot out of 50 cities identified as the top metro areas in the U.S. that offer the best overall qualities for senior living, according to a survey released by Bankers Life and Casualty Company. Read more >>
TOP TEN RECOMMENDATIONS FOR CAREGIVERS OF THOSE WITH DEMENTIA
July 31, 2007 -- Health Central -- More and more healthcare professionals are also becoming caregivers for their own aging loved ones-and struggling just like everyone else. Read more >>
July 31, 2007 -- CMS -- Medicare payments to nursing homes will increase by approximately $690 million in fiscal 2008 under new rates finalized today by the Centers for Medicare & Medicaid Services (CMS). This 3.3 percent increase will affect payment rates to nursing facilities that furnish certain skilled nursing and rehabilitation care to Medicare beneficiaries recovering from serious health problems.
The final rule for the skilled nursing facility prospective payment system (SNF PPS) is on display at the Office of the Federal Register. Read the final rule (PDF) >>
OHIO KEPRO EVENTS
THE GOOD APPLES: TIPS FOR ATTRACTING AND RETAINING THE RIGHT EMPLOYEES
In this half-day workshop, we will delve into key strategies for improving workforce retention in the nursing home, including:
- The impact of turnover and absenteeism on an organization and what you can do about it.
- Strategies to improve the hiring and orientation process.
- Motivating employees and improving staff satisfaction.
- Setting goals and measure improvement in workforce retention.
Who should attend: Directors of Operations, Directors of Nursing, Nursing Home Administrators, Staff Development, and Human Resources.
8/7 – Boardman
8/15 – Columbus
8/21 – Wellston
NURSING HOME QUALITY AFFAIR
Northeast Conference Center, Westerville, Ohio
September 11, 2007 – 9:30 to 3:30
At this meeting, we will spotlight nursing homes that achieved remarkable rates of improvement and overall performance in the areas of pain, pressure ulcers, depression, and/or the use of physical restraints.
This event is an opportunity for your nursing home to renew its quality improvement efforts by learning “what works” and discussing successful strategies at a forum of your peers.
Who should attend: Administrators/CEOs, Directors of Nursing, Direct Care Staff, Social Workers, Activities Professionals.
Download the flyer and register today!
INDUSTRY EVENTS
Skilled Nursing Facility (SNF)/Long-Term Care (LTC) Open Door Forum
August 9, 2007, 2:00PM
Dial: 1-800-837-1935
Reference Conference ID: 3648421
Medicare Learning Network:
Learning resources and products for the healthcare professional.
Alzheimer’s Association Training Events
Case Western Reserve University School of Medicine Courses
Ohio Department of Health, Technical Assistance Program – New Programs
Ohio Health Care Association Events
An archive of The Nursing Home Weekly Update is available on our Web site. Click here >>
