Nursing Home Physical Restraints Project
Fourteen Oregon nursing homes are participating in the Nursing Home Physical Restraints Project, a Medicare-funded initiative to reduce the use of unnecessary physical restraints with residents in their facilities. The initiative recognizes the importance of a resident’s right to participate in and direct his/her own care, by optimizing function and independence, promoting comfort and safe mobility, and achieving the greatest possible dignity and quality of life.
Research identifies adverse effects, physiological and psychological, associated with restraint use. This project focuses on process issues to help providers break down the barriers to safe, efficient, individualized care without using restraints. Participating nursing homes received assessments of their systems and care practices related to use of physical restraints, and many facilities have used them to develop quality improvement projects. Through education and peer sharing, these facilities are working to improve the quality of care and residents’ quality of life.
Patient safety/resident safety culture surveys
Acumentra Health is administering the Agency for Healthcare Research and Quality (AHRQ) Patient Safety/Resident Safety Culture Surveys to participating nursing homes. The surveys ask for staff opinions about the culture of resident/patient safety in their facility. Survey results will help site leaders evaluate specific safety interventions and conduct internal and external benchmarking. More information: http://www.ahrq.gov/qual/patientsafetyculture/nhsurvindex.htm
Tools and resources
Physical restraints
Physical Restraints: Systems Review Checklists (PDF)
A series of checklists designed to assess processes related to physical restraint management in nursing homes. The checklists are intended to help facilities examine their current care practices and identify areas for improvement.
MDS Restraint Coding Tip Sheet (PDF)
A summary of RAI guidance for coding physical restraints on the Minimum Data Set (MDS)
Physical Restraint Physician Order Tip Sheet (PDF)
A summary of the guidance for physician orders for physical restraints, including the components of an order, supporting documentation, and examples.
Physical Restraint Care Planning Tip Sheet (PDF)
A summary of State Operations Manual guidance and a tool to walk you through the physical restraint care planning process.
Physical Restraints RAP: Critical Thinking Tip Sheet (PDF)
A set of simple questions for assessing a resident and determining whether a restraint is really necessary.
Related resources
CMS Survey & Certification Memo 07-22 (PDF)
This CMS Memorandum to state survey agency directors clarifies terms used in the definition of physical restraints as applied to the requirements for long-term care facilities.
Rethinking the Use of Position Change Alarms (PDF)
Joanne Rader, Barbara Frank, Cathie Brady, January 2007
Position change alarms are considered restraints if they have the effect of keeping a person from moving. This article encourages nursing homes to rethink the practice, focusing instead on understanding the underlying causes of falls and instability and on developing individualized approaches that take into account the resident’s strengths, wishes, and needs.
Individualized Wheelchair Seating: For Older Adults—Part I: A Guide for Caregivers
Individualized Wheelchair Seating: For Older Adults—Part II: A Guide for Professionals
Joanne Rader, Debbie Jones, Lois Miller (Benedictine Institute for Long-Term Care, Mt. Angel, Oregon, February 1998)
Growing numbers of elderly spend much of their day in chairs that do not fit them or allow them the independence they could have. These guides were created to help caregivers and professionals recognize problems and modify seating or ask for professional help, if needed, to individualize and improve the seating for frail elderly people.
A Guide to Bed Safety: Bed Rails in Hospitals, Nursing Homes and Home Health Care: The Facts (PDF)
FDA, October 2000 (rev. January 2008)
This guidance includes recommendations for hospitals, nursing homes, and private residences.
Restraints: Bed Rail Safety Check (PDF)
Primaris, April 2009
This tool outlines seven zones on a bed system where there is potential for entrapment. The third page can be used for individual documentation.
STAR (Setting Targets Achieving Results)
This web-based tool developed for the Nursing Home Quality Initiative(NHQI) provides methods for setting improvement targets, comparing with national benchmarks, and tracking performance goals for Physical Restraints and five other quality measures
Falls in Nursing Homes
Centers for Disease Control and Prevention (CDC) web page
This web page provides information and data about falls in nursing homes, possible strategies to prevent falls, and the negative impact of physical restraints as a fall prevention measure.
Falls Investigation Guide Toolkit
A Nursing Home Expert Panel convened by the Oregon Patient Safety Commission has developed a toolkit to assist facilities in learning from falls and planning person-centered approaches to avoid harm. We will post the toolkit when it has been finalized.
Hand hygiene
Last updated April 14, 2011