11.A.
Physical Restraints
The resident has the right to be free from any physical
restraints imposed for purposes of discipline or convenience, and not required
to treat the resident's medical symptoms.
"Physical Restraints" are defined as any manual
method or physical 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.
"Discipline" is any action taken by the
facility for the purpose of punishing or penalizing residents.
"Convenience" is any action taken by the
facility to control resident behavior or maintain residents with a lesser
amount of effort by the facility and not in the residents' best
interest.
11.A.1. All restraints must
be ordered by a physician. PRN orders for restraints are prohibited.
11.A.2. Documented evidence of less
restrictive measures to promote greater functional independence must be present
in the medical record if restraints are used. The care plan must address the
medical reason for which the restraints are used. The care plan must also
contain a succession of approaches to be utilized before restraints are
applied. Consultation with appropriate health professionals regarding the use
of less restrictive approaches must be obtained when appropriate. Locked
restraints are prohibited in any case.
a.
Geriatric and other chairs from which the resident cannot arise without
assistance and which impede movement are considered a physical
restraint.
b. Bedrails are
considered restraints when they are a barrier to the resident for getting out
of bed.
11.A.3. If a
trial of less restrictive measures is unsuccessful, and the facility decides
that a physical restraint would enable and promote greater functional
independence, then the restraining device may be used only for specific
time-limited periods.
11.A.4. The
continued use of restraints must be evaluated as needed, but at least
quarterly.
11.A.5. There must be
documented evidence that the resident, family, or legal guardian is aware of
and agrees with this treatment.
11.A.6. All resident care staff shall be
trained in the proper application and use of restraints.
11.A.7. Restraints may not be used to permit
staff to administer treatment to which the resident has not
consented.
11.A.8. No resident may
be in a restraint without nursing staff on duty at all times in that section of
the facility;
11.A.9. Restraints
are released for at least fifteen (15) minutes every two (2) hours and exercise
provided. A written record is kept of the times of restraint and
release.
11.A.10. Every resident in
restraint is offered toilet privileges at least every two (2) hours or when
request is made.
11.A.11. When the
resident is in bed, the restraint must be properly applied to allow the
resident to turn in bed. It is not necessary to release a restraint during the
resident's normal sleeping hours, but the restraint must be checked at least
every two (2) hours. A written record must be maintained of restraint
checks.
11.A.12. Leather cuff and
any crotch restraints shall not be used. Four-point restraints are
prohibited.
11.A.13. Residents
shall not be confined in a locked room; dutch doors are permissible, provided
the top section is opened.
11.B.
Chemical Restraints
The resident has the right to be free from any chemical
restraints imposed for the purpose of discipline or convenience and not
required to treat the resident's medical symptoms. These drugs are categorized
as antipsychotics, antidepressants, anxioltics and hypnotics.
"Chemical Restraint" is a psychopharmacologic
drug that is used for discipline or convenience and is not required to treat
medical symptoms.
"Discipline" is any action taken by the
facility for the purpose of punishing or penalizing residents.
"Convenience" is any action taken by the
facility to control resident behavior or maintain residents with a lesser
amount of effort by the facility and not in the residents' best
interest.
11.B.1. There must be
evidence of a physical examination to rule out physical cause.
11.B.2. Residents receiving antipsychotic
medications must receive gradual dose reductions and behavioral monitoring in
an effort to discontinue these drugs, unless clinically contra
indicated.
11.B.3. There must be
documented evidence of less restrictive measures, including interventions to
modify the resident's behavior or the environment, including staff approaches
to care, treat or manage the resident's behavioral symptoms.
11.B.4. There must be evidence that the
resident, family or legal guardian is made aware of potential side effects and
agrees with this treatment.
11.B.5.
Psychoactive drugs may not be used:
a. In
quantities that interfere with the resident's level of alertness and ability to
participate in rehabilitation programs; or
b. On an as needed basis exceeding five (5)
times in a seven (7) day period;
11.B.6. The use of chemical restraints will
be part of the care plan, which will address the medical reason for which the
medication is used, with a succession of approaches and interventions to be
utilized prior to the administration of chemical restraints.
11.B.7. Close monitoring at regular
intervals, as determined by the physician and multidisciplinary team, of all
residents receiving psychoactive drugs will be maintained.
