TIP OF THE WEEK
Myths and Facts About Physical Restraints
According to the Centers for Medicare & Medicaid Services (CMS), restraint use in long-term care presents key issues for patient safety. Research and standards of practice show that the belief that restraints ensure safety is often unfounded. In practice, restraints can have negative consequences and risks that outweigh the benefits in some cases. [1]
The physical restraint quality measure (QM) reflects the percent of residents in the nursing home who were physically restrained daily during the seven-day assessment period. The Advancing Excellence in America’s Nursing Homes Campaign seeks to reduce the national QM rate to at or below five percent by September 2008. As of the third quarter of 2007, the national rate has met this goal, but Ohio has not.
QM: Use Physical Restraints | Third Quarter, 2007 |
|
National Rate |
4.99% |
Ohio |
5.48% |
CMS defines a physical restraint 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.” [2]
If a restraint is in use, it is important to keep in mind the medical symptoms that are being treated and the many risks related to restraint use. Remember, a device may have the effect of restraining one individual, but not another, depending of the individual resident’s condition and circumstances. [3] If there is not a medical reason for the restraint, it should not be used. Restraints must never be used to punish a person or to make a person easier to handle. A physician order is needed before any restraint can be used. [4]
DO YOU KNOW THE FACTS ABOUT RESTRAINTS?
Test your knowledge with these common myths and facts.
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Restraints prevent falls and injuries.
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It is a nursing home's moral responsibility to prevent all falls.
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Residents do not mind being restrained. It makes them feel secure.
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Side rails may be considered a restraint.
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Education/training to staff, patient/family, and physicians is needed to create and implement a safe and comfortable environment for the patient.
Myth! Studies show restraints do not prevent falls and often cause more injuries and even deaths. [4]
Myth! Nursing homes are responsible for caring for people and helping them stay as healthy and happy as possible. It is important to identify causes for falls and prevent them. But falls happen, even with the right safeguards in place. [4]
Myth! No one likes to feel helpless, trapped, or demeaned. A restraint can cause your loved one to become angry, depressed, confused, agitated, or withdrawn. Few of us would ever choose restraint use for ourselves. [4]
Fact! Side rails present an inherent safety risk, particularly when the patient is elderly or disoriented. Even when a side rail is not intentionally used as a restraint, patients may become trapped between the mattress or bed frame and the side rail. Disoriented patients may view a raised side rail as a barrier to climb over, may slide between raised, segmented side rails, or may scoot to the end of the bed to get around a raised side rail. When attempting to exit the bed by any of these routes, the patient is at risk for entrapment, entanglement, or falling from a greater height posed by the raised side rail, with a possibility for sustaining greater injury or death than if he/she fallen from the height of a lowered bed without raised side rails. [5]
Fact! An individualized patient assessment needs to be completed before any restraint is implemented or removed. Any decision regarding restraint use should be made within the framework of an individual patient assessment. If a restraint has been determined to be necessary, steps should be taken to reduce the known risks associated with its use. [6]
Use restraints only after exhausting all reasonable alternatives. Develop a nursing plan of care tailored to the patient’s presenting problem(s) and risk factors. Choose the least restrictive device, monitor and reassess for eliminating. [7]
RESOURCE SPOTLIGHT
Restraints Jeopardy
Restraint Jeopardy can be used as a fun review for an all-staff inservice. Categories include: True or False; Risk Factors; Let's Get Specific (types); Alternatives; and "Tying it all Together."
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INDUSTRY EVENTS
Beginning the Culture Change Journey -- May 15, 2008
Cuyahoga Community College East, Cleveland, Ohio
In this one-day program, Elise Tareshawty, LNHA will discuss core elements of transformational culture change, including communication techniques, meeting the regulations, and the importance of leadership.
Eden International Conference, Columbus, Ohio –- June 3-6, 2008
The fourth international conference will be held in Columbus this year. This is an excellent opportunity to network with industry leaders from all over the world -- to hear their stories and to share your own.
Health Policy Institute of Ohio: Regional Meetings on the Ohio Family Violence Prevention Project
Consistent Assignment – The Practice and the Experience
June 3, 2008, 2:00 to 3:30 PM. Register now. (registration closes May 29, 2008)
Dial in to this teleconference hosted by the Advancing Excellence in America’s Nursing Home Campaign to learn what consistent assignment really is, why it works, and how to do it! We’ll also hear from several nursing homes that have done it and been successful at it.
Handouts will be available after May 29, 2008 on www.nhqualitycampaign.org.
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
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