Physical Restraint Jeopardy

1
Physical Restraint Jeopardy brought to you by
the New Mexico Medical Review Association
(NMMRA)
2
Tying It All Together
True or False
Risk Factors
Lets Get Specific!
Alternatives
100
100
100
100
100
200
200
200
200
200
300
300
300
300
300
400
400
400
400
400
500
500
500
500
500
Exit
3

True or False

• If a device restricts freedom of movement or
  access to ones body, it is considered a
  restraint

What is true?
4

True or False

• Placing a residents bed against the wall may be
  a restraint

What is true?
5

True or False

• The facility must attempt and document restraint
  alternatives prior to use of a restraint

What is true?
6

True or False

• Bean bags are not considered a restraint

What is false?
7

True or False

• Restraints may put a resident at higher risk of
  injury

What is true?
8

Risk Factors

• Three conditions that would put an elder at risk
  for restraint use

• What are
• Dementia
• Unsteady gait
• Decline in mobility
• Wandering
• Falls
• Agitation

9

Risk Factors

• Prevention is the best care you can give to a
  person who is at high risk for restraints
• (True or False)

What is true?
10

Risk Factors

• Three environmental factors to consider when
  providing care to someone at risk for restraint
  use

• What are
• Clear pathways
• Clutter-free rooms
• Arrangement of rooms
• Appropriate height levels for bed and toilet
• Adequate lighting
• Overhead trapeze and non-skid surfaces as
  appropriate

11

Risk Factors

• Two care practices to minimize the use of
  restraints for residents at risk

• What are
• Fall prevention programs
• Restorative exercises
• Rehabilitation programs
• Distractions
• Activity boxes
• Television
• Social events

12
Risk Factors

• Three potential outcomes of using a physical
  restraint

• What are
• Pressure ulcers
• Permanent loss of mobility
• Depression
• Loss of independence
• Increased incontinence
• Increased seriousness of fall-related injuries
• Strangulation
• Circulation impairment
• Social isolation
• Contractures
• Death

13

Lets Get Specific

• Three examples of mechanical devices that could
  be used as a restraint

• What are
• Table
• Siderails
• Chairs
• Walls
• Trays
• Sheets
• Canes stuck through spokes of wheelchairs

14

Lets Get Specific
DOUBLE JEOPARDY!

• Three examples of physical restraints

• What are
• Lap trays/Lap buddies
• Lap cushions
• Vest restraints
• Hand mitts
• Geri chair/recliner

15

Lets Get Specific

• Any manual method, physical or mechanical device,
  material, or equipment attached or adjacent to
  the residents body that the individual cannot
  remove easily which restricts freedom of movement
  or normal access to ones body.

What is a physical restraint?
16

Lets Get Specific

• Double Restraint

What is using more than one restraint, such as a
seatbelt and a table tray?
17

Lets Get Specific

• Tucking in or using Velcro to hold a sheet,
  fabric or clothing tight to restrict movement

What is restraint?
18

Alternatives

• Three ways to enhance sleep that may reduce the
  need for restraints

• What are
• Reducing noise
• Bedtime rituals
• Individual toileting plan at night, avoid waking
  if possible
• Avoiding caffeine in evening
• Avoiding fluids after 7 p.m.
• Comfortable room temperature, lighting

19

Alternatives

• One method to strengthen a resident to avoid
  falls

• What is
• CRA Program
• Therapy
• Walk-to-dine programs
• Exercise programs with restorative activities
• Arrange room to encourage ambulation and movement
• Balance and fall education

20

Alternatives

• Two restraint alternatives for a resident who
  frequently falls out of bed

• What are
• Low bed
• Mat on floor
• Scoop mattress
• Night light
• Review individual toileting program
• Assess why getting up investigate!
• Anticipate needs know your residents!

21

Alternatives

• Two restraint alternatives for a resident who
  slides out of the chair

• What are
• Evaluate sleep/rest patterns
• Keep resident in area with staff supervision
• Strengthening/posture control programs
• Slant or wedge cushions
• High back chair
• Solid seat
• Pommel cushion
• Trunk bolsters
• Armed chairs
• Assess chair for proper fit and size

22

Alternatives

• Of these restraint alternatives, the one which
  would not be considered a restraint
• Half rails
• Body alarms
• Body pillow or wedge cushion used in bed
• Non-skid strips on the floor

What are non-skid strips on the floor?
23

Tying It All Together

• The maximum number of hours that individuals may
  be restrained before being released for 15
  minutes of exercise, according to law.

What is two?
24

Tying It All Together

• The approximate number of individuals per year
  who die from strangulation or suffocation from
  restraints.

What is 200?
25

Tying It All Together
DOUBLE JEOPARDY!

• The Internet site where the general public can
  view nursing home restraint scores along with
  other quality measures.

What is Nursing Home Compare? www.medicare.gov/NHc
ompare
26

Tying It All Together

• A physicians order alone

What is not considered sufficient to warrant the
continued use of restraints
27

Tying It All Together

• Restraint reduction efforts must always focus on
  this person

What is the individual resident?
28
Thanks for your participation
This material was prepared by the New Mexico
Medical Review Association (NMMRA), the Medicare
Quality Improvement Organization for New Mexico,
under contract with the Centers for Medicare
Medicaid Services (CMS), an agency of the U.S.
Department of Health and Human Services. It is
based on information developed by the Kansas
Foundation for Medical Care. The Jeopardy Game
template is adapted from the work of Susan
Collins and Eleanor Savko, District Resource
Teachers for Hardin County Schools. The contents
presented do not necessarily reflect CMS policy.
9SOW-NM-PS-09-95