Physical Restraint Jeopardy brought to you by the: New Mexico Medical Review Association (NMMRA)

1. Physical Restraint Jeopardy brought to you by the: New Mexico Medical Review Association (NMMRA)

2. “Tying” It All Together True or False Let’s Get Specific! Risk Factors 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 one’s body, it is considered a restraint What is “true”?

4. True or False Placing a resident’s 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. Let’s 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. Let’s 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. Let’s Get Specific Any manual method, 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. What is a physical restraint?

16. Let’s Get Specific Double Restraint What is using more than one restraint, such as a seatbelt and a table tray?

17. Let’s 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/NHcompare

26. “Tying” It All Together A physician’s 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