The Percent of Residents Who Were Physically Restrained is a long-stay quality measure. This measure looks at residents who were physically restrained on a daily basis.
The numerator for the long stay measure is all residents with a selected target assessment that includes daily physical restraints. This includes the following as indicated on the MDS:
- Trunk restraint used in bed (P0100B = 2), or
- Limb restraint used in bed (P0100C = 2), or
- Trunk restraint used in chair or out of bed (P0100E = 2), or
- Limb restraint used in chair or out of bed (P0100F = 2), or
- Chair prevents rising used in chair or out of bed (P0100G = 2).
The denominator is all residents with a selected target assessment, without exclusions.
Assessments are excluded if a dash is entered for any of the items noted above (P0100B, P0100C, P0100E, P0100F, P0100G). There are no covariates for this measure.
State Surveyors review the Physical Restraints Critical Element Pathway in relation to this measure. The items reviewed can be utilized to assess your facilities approach to restraints and restraint reduction.
The first step is ensuring restraint are used compliantly. The restraint MUST:
- Be necessary to treat a medical symptom;
- Be the least restrictive device possible, in use for the least amount of time perday possible, AND the facility must have an action planin place to decrease usage or eventual removal of the restraint;
- NOT be used to discipline a resident orfor staff convenience in the absence of a medical symptom;
- NOT be used because of family request inthe absence of a medical symptom.
The assessments, care plans, and orders for residents with restraints should be reviewed and corroborated by observation, interview, and further record review. Ensure the type of restraint in place matches the medical record and is applied correctly throughout the day. If there is a change in the residents condition, be sure to reassess the continued need for a restraint.
This measure can be addressed by the Interdisciplinary Team. Refer residents to occupational, physical, or speech therapy for individual and group interventions to address mobility, ADLs, positioning, communication, and pain management. Discuss with resident, family members, and caregivers’ resident preferences, hobbies, likes, dislikes, and daily routines to minimize the potential need for a restraint.
Utilize QAPI to address facility and resident level opportunities for improvement. Ensure the medical record indicates the need for a restraint and involve the medical director in reviewing patient records, medications, and possible needs.
The overall goal for improvement with this quality measure is to limit restraint use and to improve overall quality of life.