ELIMINATING RESTRAINTS IN ASSISTED LIVING

1. ELIMINATING RESTRAINTS INASSISTED LIVING Presented by Jim Tiffany

2. Perception Perception YELLOWBLUEORANGEBLACKRED GREENPURPLEYELLOWREDORANGE GREENBLACKBLUERED PURPLEGREENBLUEORANGE YELLOWBLUEORANGEBLACKREDGREENPURPLEYELLOWREDORANGEGREENBLACKBLUEREDPURPLEGREENBLUEORANGE

4. 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;

5. 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.

6. Exceptions There are NO EXCEPTIONS!

7. “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 resident’s physical ability, cognition, the reason the device is being used, etc., etc, etc…

8. 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. Remember…

10. 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

11. 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

12. 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, than…where 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. MYTHS AND FACTS: BED RAILS

13. 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. MYTHS AND FACTS: BED RAILS

14. 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 MYTHS AND FACTS: BED RAILS

17. 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? • IfNO,it is not a physical restraint • If YES, proceed to question C • C. Is the garment or device used to control behavior? • IfNO, 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.

18. 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?

19. 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?

20. 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?

21. 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

22. 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

23. QUESTIONS Phoenix main: 602-364-2639 Fax: 602-364-4766 Tucson main: 520-628-6965 Fax: 520-628-6991 Flagstaff: 928 226-0156 Fax: 928 774- 2830 • www.azdhs.gov/als/hcb Thank You