Before working to reduce restraint use, a facility must ensure that its staff members have a complete understanding of what is considered a restraint. According to the RAI User’s Manual for the MDS 3.0, a physical restraint is “any manual method 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.”
Knowing the definition of a restraint is necessary not only to identify restraints, which must be done prior to starting a reduction program, but also to properly code these devices on the MDS 3.0.
The RAI User’s Manual for the MDS 3.0 provides clarifications for words and phrases included in the definition for physical restraints. Some of these clarifications are as follows:
- “Remove easily” means that the manual method, device, material, or equipment can be removed intentionally by the resident in the same manner as it was applied by the staff (e.g., side rails are put down or not climbed over, buckles are intentionally unbuckled, ties or knots are intentionally untied), considering the resident’s physical condition and ability to accomplish his or her objective (e.g., transfer to a chair or get to the bathroom in time).
- “Freedom of movement” means any change in place or position of the body or any part of the body that the person is physically able to control or access.
- “Medical symptoms/diagnoses” are defined as an indication or characteristic of a physical or psychological condition. Objective findings derived from clinical evaluation of the resident’s medical diagnoses and subjective symptoms should be considered when determining the presence of medical symptoms that might support restraint use. The resident’s subjective symptoms may not be used as the sole basis for using a restraint. In addition, the resident’s medical symptoms/diagnoses should not be viewed in isolation; rather, the medical symptoms identified should become the context in which to determine the most appropriate method of treatment related to the resident’s condition, circumstances, and environment, not a way to justify restraint use.
If it is determined, after thorough evaluation and attempts at using alternative treatments and less restrictive methods, that a restraint must still be employed, the medical symptoms that support the use of restraints must be documented in the resident’s medical record, ongoing assessments, and care plans. There also must be a physician’s order reflecting the use of the restraint and the specific medical symptom being treated by its use. The physician’s order alone is not sufficient to employ the use of a restraint. CMS will hold the nursing home ultimately accountable for the appropriateness of that determination.
Source: The RAI User’s Manual for the MDS 3.0, Chapter 3, pp. P-3 through P-4.