ELIMINATING RESTRAINTS IN ASSISTED LIVING

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ELIMINATING RESTRAINTS INASSISTED LIVING

• Presented by
• Jim Tiffany

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Perception
Perception

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Resident Rights

• R9-10-710.D.3. A licensee shall ensure that a
  resident has the following rights
• To be free from abuse, neglect, exploitation, and
  physical restraints and chemical restraints

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Definitions

• R9-10-701.80. "Physical restraint" means the
  confinement of a resident or the use of any
  article, device, or garment that cannot be
  removed by a resident, used to restrict movement,
  and control the resident's behavior.
• R9-10-701.21. "Chemical restraint" means any
  medication that is administered for purposes of
  discipline or convenience and is not required to
  treat a resident's medical symptoms.

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Exceptions

• There are
• NO
• EXCEPTIONS!

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It depends

• Whether or not an article of clothing or a device
  is a restraint or a hazard for a particular
  resident depends on a number of factors,
  including the residents physical ability,
  cognition, the reason the device is being used,
  etc., etc, etc

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Remember

• It is YOUR RESPONSIBILITY to protect the
  residents in your facility.
• If residents are at risk for falling, you must
  take steps to ensure their safety.

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Bed Rails

• Between January 1, 1985 and January 1, 2008, FDA
  received 772 incidents of patients caught,
  trapped, entangled, or strangled in beds with
  rails. The reports included 460 deaths, 136
  nonfatal injuries, and 176 cases where staff
  needed to intervene to prevent injuries. Most
  patients were frail, elderly or confused.
• Source FDA website

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Bed Rails

• Patients at highest risk for entrapment are older
  or frail adults and those who have conditions
  such as agitation, delirium, confusion, pain,
  uncontrolled body movement, hypoxia, fecal
  impaction, or acute urinary retention. These
  conditions make them likely to move about in the
  bed or try to get out of it.
• Source FDA website

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Minnesotas Success

• Push to remove bed rails by state regulators
  began in mid-1990s
• Nursing homes were fined aggressively in some
  cases up to 70,000 for not protecting residents.
• Dialogue statewide resulted in increased
  awareness, increased provider and family
  knowledge.
• Since 1995, the number of nursing home patients
  using bed rails has plummeted from 14,2000 to
  fewer than 500. Some patients fall more often,
  but the number of serious injuries has declined.

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MYTHS AND FACTS BED RAILS

• MYTH
• Bed Rails are a safe and effective means of
  preventing patients from falling out of bed.

• FACT
• The potential for serious injury is more likely
  from a fall from a bed with raised side rails,
  thanwhere side rails are not used.
• (Source The Centers for Medicare and Medicaid
  Services)
• In Minnesota, after a campaign to reduce bed rail
  use, it was found that some patients fall more
  often, but the number of serious injuries has
  declined.

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MYTHS AND FACTS BED RAILS

• MYTH
• Partial bed rails are not restraints.

• FACT
• Partial rails may assist one resident to enter
  and exit the bed independently while acting as a
  restraint for another.

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MYTHS AND FACTS BED RAILS

• MYTH
• But this resident needs bed rails or he/she will
  fall.

• FACT
• Alternatives include
• Low-height beds
• Floor mats
• Motion sensors
• Bed alarms
• Individualized toileting schedules
• Adequate pain control
• Individualized activity programs

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Criteria test for Physical Restraints

• Potential physical restraints are observed during
  the tour of the facility.
• Questions to ask
• A. Can the resident remove the garment or device
  without help?
• If YES, it is not a physical restraint
• If NO, proceed to question B
• B. Is the garment or device used to restrict
  movement?
• If NO, it is not a physical restraint
• If YES, proceed to question C
• C. Is the garment or device used to control
  behavior?
• If NO, it is not a physical restraint
• If YES, it is a PHYSICAL RESTRAINT
• In order to cite as a physical restraint
• ALL 3 conditions must be met.

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Physical Restraint or Hazard Scenario 1

• The Surveyor observes an 83 y/o resident laying
  in bed. There are full-length rails on both
  sides of the bed, and both rails are in the up
  position.
• The manager says that the resident needs the
  rails to keep him from falling out of bed.
• Is this a restraint? A hazard?

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Physical Restraint or Hazard Scenario 2

• The Surveyor observes an 83 y/o resident laying
  in bed. There are full-length rails on both
  sides of the bed, and both rails are in the up
  position.
• The Surveyor asks the resident if she can lower
  one of the rails. The resident does not respond.
• The manager states that the resident cannot lower
  the rails, and that the rails are in place
  because the family is concerned that she may fall
  out of bed in her sleep.
• Is this a restraint? A hazard?

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Physical Restraint or Hazard Scenario 3

• The Surveyor observes an 83 y/o resident laying
  in bed. There are full-length rails on both
  sides of the bed, and both rails are in the up
  position.
• The Surveyor asks the resident if she can lower
  one of the rails. The resident does not respond.
• The manager states that the resident cannot lower
  the rails, and that the rails are needed because
  the resident has a history of trying to get out
  of bed during the night and falls.
• Is this a restraint? A hazard?

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Online Resources

• http//www.azdhs.gov/als/hcb/index.htm
• Frequently Asked Questions
• License renewal application
• Survey tool
• Caregiver/manager training programs
• Facility Directory, including Statements of
  Deficiencies and Enforcement actions
• Informal Dispute Resolution (IDR) Process
• Links to rules, statutes, and enforcement actions

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Online Resources

• The Arizona Board of Examiners of Nursing Care
  Institution Administrators and Assisted Living
  Facility Managers.
• http//www.nciabd.state.az.us/
• Approved continuing education programs
• Directory of certified managers
• Enforcement actions
• Links to rules and statutes
• Application forms Initial, renewal, duplicate

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QUESTIONS

• Phoenix main 602-364-2639
• Fax [phone]
• Tucson main 520-628-6965
• Fax [phone]
• Flagstaff 928 226-0156
• Fax [phone]
• www.azdhs.gov/als/hcb
• Thank You