eliminating restraints in assisted living presented by jim tiffany
TRANSCRIPT
ELIMINATING RESTRAINTS ELIMINATING RESTRAINTS
ININASSISTED LIVINGASSISTED LIVING
Presented by Presented by
Jim TiffanyJim Tiffany
PerceptionPerception
YELLOWYELLOW BLUEBLUE ORANGEORANGEBLACKBLACK REDRED GREEN GREEN
PURPLEPURPLE YELLOWYELLOW REDREDORANGE ORANGE GREENGREEN BLACKBLACK
BLUEBLUE REDRED PURPLE PURPLEGREENGREEN BLUEBLUE ORANGEORANGE
PerceptionPerception
YELLOWYELLOW BLUEBLUE ORANGEORANGEBLACKBLACK REDRED GREENGREEN
PURPLEPURPLE YELLOWYELLOW REDREDORANGEORANGE GREENGREEN BLACKBLACK
BLUEBLUE REDRED PURPLEPURPLEGREENGREEN BLUEBLUE ORANGEORANGE
Resident RightsResident Rights
• R9-10-710.D.3. A licensee shall R9-10-710.D.3. A licensee shall ensure that a resident has the ensure that a resident has the following rights:following rights:
• To be free from abuse, neglect, To be free from abuse, neglect, exploitation, and physical restraints exploitation, and physical restraints and chemical restraints;and chemical restraints;
DefinitionsDefinitions
• R9-10-701.80. "Physical restraint" means the R9-10-701.80. "Physical restraint" means the confinement of a resident or the use of any confinement of a resident or the use of any article, device, or garment that cannot be article, device, or garment that cannot be removed by a resident, used to restrict removed by a resident, used to restrict movement, and control the resident's behavior. movement, and control the resident's behavior.
• R9-10-701.21. "Chemical restraint" means any R9-10-701.21. "Chemical restraint" means any medication that is administered for purposes of medication that is administered for purposes of discipline or convenience and is not required to discipline or convenience and is not required to treat a resident's medical symptoms.treat a resident's medical symptoms.
Exceptions Exceptions
There areThere are
NO NO EXCEPTIONS!EXCEPTIONS!
““It depends…”It depends…”•Whether or not an article of Whether or not an article of
clothing or a device is a clothing or a device is a restraintrestraint or a or a hazardhazard for a particular for a particular resident depends on a number of resident depends on a number of factors, including the resident’s factors, including the resident’s physical ability, cognition, the physical ability, cognition, the reason the device is being used, reason the device is being used, etc., etc, etc…etc., etc, etc…
Remember…Remember…
• It is YOUR It is YOUR RESPONSIBILITY to RESPONSIBILITY to protect the protect the residents in your residents in your facility.facility.
• If residents are at If residents are at risk for falling, you risk for falling, you must take steps to must take steps to ensure their safety.ensure their safety.
Bed RailsBed Rails
• Between January 1, 1985 and January 1, Between January 1, 1985 and January 1, 2008, FDA received 772 incidents of 2008, FDA received 772 incidents of patients caught, trapped, entangled, or patients caught, trapped, entangled, or strangled in beds with rails. The reports strangled in beds with rails. The reports included 460 deaths, 136 nonfatal included 460 deaths, 136 nonfatal injuries, and 176 cases where staff injuries, and 176 cases where staff needed to intervene to prevent injuries. needed to intervene to prevent injuries. Most patients were frail, elderly or Most patients were frail, elderly or confused. confused.
• Source: FDA websiteSource: FDA website
Bed RailsBed Rails
• Patients at highest risk for entrapment Patients at highest risk for entrapment are older or frail adults and those who are older or frail adults and those who have conditions such as agitation, have conditions such as agitation, delirium, confusion, pain, uncontrolled delirium, confusion, pain, uncontrolled body movement, hypoxia, fecal body movement, hypoxia, fecal impaction, or acute urinary retention. impaction, or acute urinary retention. These conditions make them likely to These conditions make them likely to move about in the bed or try to get move about in the bed or try to get out of it. out of it.
• Source: FDA websiteSource: FDA website
MYTHS AND FACTS: BED MYTHS AND FACTS: BED RAILSRAILS
MYTHMYTH
Bed Rails are a Bed Rails are a safe and safe and
effective means effective means of preventing of preventing patients from patients from falling out of falling out of
bed.bed.
FACTFACT
““The potential for serious The potential for serious injury is more likely from injury is more likely from a fall from a bed with a fall from a bed with raised side rails, than…raised side rails, than…where side rails are not where side rails are not used.” used.”
(Source: The Centers for Medicare and (Source: The Centers for Medicare and Medicaid Services)Medicaid Services)
In Minnesota, after a In Minnesota, after a campaign to reduce bed campaign to reduce bed rail use, it was found rail use, it was found that some patients fall that some patients fall more often, but the more often, but the number of serious number of serious injuries has declined.injuries has declined.
MYTHS AND FACTS: BED MYTHS AND FACTS: BED RAILSRAILS
MYTHMYTH
Partial bed rails Partial bed rails are not are not
restraints.restraints.
FACTFACT
Partial rails may Partial rails may assist one assist one resident to enter resident to enter and exit the bed and exit the bed independently independently while acting as a while acting as a restraint for restraint for another.another.
MYTHS AND FACTS: BED MYTHS AND FACTS: BED RAILSRAILS
MYTHMYTH
““But this resident But this resident needsneeds bed rails bed rails or he/she will or he/she will
fall.”fall.”
FACTFACT• Alternatives include:Alternatives include:
– Low-height bedsLow-height beds– Floor matsFloor mats– Motion sensorsMotion sensors– Bed alarmsBed alarms– Individualized toileting Individualized toileting
schedulesschedules– Adequate pain controlAdequate pain control– Individualized activity Individualized activity
programsprograms
Criteria test for Physical Criteria test for Physical RestraintsRestraints• Potential physical restraints are observed Potential physical restraints are observed
during the tour of the facility.during the tour of the facility.• Questions to ask:Questions to ask:
A.A. Can the resident remove the garment or device without help? Can the resident remove the garment or device without help? If YES, it is not a physical restraintIf YES, it is not a physical restraint If NOIf NO, , proceed to question proceed to question BB
B.B. Is the garment or device Is the garment or device used to restrict movement? used to restrict movement? IfIf NO,NO, it is not a physical restraintit is not a physical restraint If YESIf YES, proceed to question , proceed to question CC
C. C. Is the garment or device Is the garment or device used to control behavior?used to control behavior? IfIf NO, it is not a physical restraintNO, it is not a physical restraint If YESIf YES, it is a PHYSICAL RESTRAINT , it is a PHYSICAL RESTRAINT
•In order to cite as a physical In order to cite as a physical restraint:restraint:
•ALL 3 conditions must be met.ALL 3 conditions must be met.
Physical Restraint or Hazard – Physical Restraint or Hazard – Scenario 1Scenario 1
• The Surveyor observes an 83 y/o resident The Surveyor observes an 83 y/o resident laying in bed. There are full-length rails on laying in bed. There are full-length rails on both sides of the bed, and both rails are in both sides of the bed, and both rails are in the up position.the up position.
• The manager says that the resident needs The manager says that the resident needs the rails to keep him from falling out of the rails to keep him from falling out of bed.bed.
• Is this a restraint? A hazard?Is this a restraint? A hazard?
Physical Restraint or Hazard – Physical Restraint or Hazard – Scenario 2Scenario 2
• The Surveyor observes an 83 y/o resident The Surveyor observes an 83 y/o resident laying in bed. There are full-length rails on laying in bed. There are full-length rails on both sides of the bed, and both rails are in both sides of the bed, and both rails are in the up position.the up position.
• The Surveyor asks the resident if she can The Surveyor asks the resident if she can lower one of the rails. The resident does not lower one of the rails. The resident does not respond.respond.
• The manager states that the resident cannot The manager states that the resident cannot lower the rails, and that the rails are in place lower the rails, and that the rails are in place because the family is concerned that she because the family is concerned that she may fall out of bed in her sleep.may fall out of bed in her sleep.
• Is this a restraint? A hazard?Is this a restraint? A hazard?
Physical Restraint or Hazard – Physical Restraint or Hazard – Scenario 3Scenario 3
• The Surveyor observes an 83 y/o resident The Surveyor observes an 83 y/o resident laying in bed. There are full-length rails on laying in bed. There are full-length rails on both sides of the bed, and both rails are in both sides of the bed, and both rails are in the up position.the up position.
• The Surveyor asks the resident if she can The Surveyor asks the resident if she can lower one of the rails. The resident does not lower one of the rails. The resident does not respond.respond.
• The manager states that the resident cannot The manager states that the resident cannot lower the rails, and that the rails are needed lower the rails, and that the rails are needed because the resident has a history of trying because the resident has a history of trying to get out of bed during the night and falls.to get out of bed during the night and falls.
• Is this a restraint? A hazard?Is this a restraint? A hazard?
Online ResourcesOnline Resources
• http://www.azdhs.gov/als/hcb/index.htmhttp://www.azdhs.gov/als/hcb/index.htm• Frequently Asked QuestionsFrequently Asked Questions• License renewal application License renewal application • Survey toolSurvey tool• Caregiver/manager training programsCaregiver/manager training programs• Facility Directory, including Statements of Facility Directory, including Statements of
Deficiencies and Enforcement actionsDeficiencies and Enforcement actions• Informal Dispute Resolution (IDR) ProcessInformal Dispute Resolution (IDR) Process• Links to rules, statutes, and enforcement Links to rules, statutes, and enforcement
actionsactions
Online ResourcesOnline Resources
• The Arizona Board of Examiners of Nursing The Arizona Board of Examiners of Nursing Care Institution Administrators and Assisted Care Institution Administrators and Assisted Living Facility Managers.Living Facility Managers.
• http://www.nciabd.state.az.us/http://www.nciabd.state.az.us/
• Approved continuing education programsApproved continuing education programs• Directory of certified managersDirectory of certified managers• Enforcement actionsEnforcement actions• Links to rules and statutesLinks to rules and statutes• Application forms: Initial, renewal, duplicateApplication forms: Initial, renewal, duplicate
QUESTIONSQUESTIONS
Phoenix main: Phoenix main: 602-364-2639602-364-2639Fax:Fax: 602-364-4766602-364-4766
Tucson main:Tucson main: 520-628-6965520-628-6965 Fax:Fax: 520-628-6991520-628-6991
Flagstaff: 928 226-0156 Flagstaff: 928 226-0156 Fax:Fax: 928 774- 2830928 774- 2830
– www.azdhs.gov/als/hcbwww.azdhs.gov/als/hcb
Thank YouThank You