now considered a restraint?

[ktwlpn]

We have recently had a mock survey at the LTC.Seems that now the low chair (adirondack style) is considered a restraint.When I first started using them years ago I understood that they are not a restaint because the resident can get up-the chair just slows them down ...They have been a Godsend on the Alzheimer's units-We all know that you can care plan frequent fallers out the wazoo and do everything exactly right-toileting,snacks,drinks,pain med etc and sometimes it's just sun-downing.Has the dept.of health forgotten that there is NO PILL for this? We have been a restraint free facility for years but are no longer considered as such due to the LOW CHAIRS! Also-floor mats at hs-A RESTRAINT? Get outta here...We can cotinie to use these devices but we have to document them as restraint-some of the nurses did not wish to do so and dc'd a rash of chairs 2 weeks ago and as a result have had several residents fracture hips....Seems that every year the DOH arrives they have a different focus and are getting more and more un-realistic...We can no longer careplan "call bell exempt" residents such as people in PVS.We have to always make sure their call bell is within reach..Last year they found our activities deficient for the minimally responsive and comatose residents so many of the programs that were very popular with our alert and independendent residents were dc'd to enable the activity staff to spend more ONE TO ONE TIME with those lower functioning residents.This year when they come back they are going to really hear lots of complaints from the rest of the residents and many of their families,too...I get that the DOH thinks that those more active residents are able to get out and find companionship in the facility but all they do is sit and look at each other-or fuss and fight. It's just dis-heartening...I really believe that most of us are in it because we really care and want the best for the residents but the BS never stops,does it? Administrative BS,physician BS,resident and family BS,charhe nurse BS-it's al BS.....Can you tell I need an attitude adjustment today? What are the rest of you hearing from the dept of health ? Enlighten me,please-I hate to be in the dark.a...nd it is very very dark today....

[EmerNurse, BSN, RN]

It's interesting, because where I work in the ER, we're told to prevent falls from folks with AMS (post-ictal, hypoxic,whatever) by making sure the stretcher rails are up and no one's told us that is considered a restraint. Go figure.

That said, will they next want us to keep everyone standing on the assumption that if they're already standing, they can't "try to get up" and fall? Good grief, I have the UTMOST respect for you nurses and aids that stick it out in LTC and do a good job.

If the state REALLY wants a restraint-free facility, and they keep upping the definition of restraint, they need to STAFF BETTER. For pete's sake, you all are damned if you do and damned if you don't!

Just another example of the way staffs' hands are tied in healthcare, but the blame is ALL OURS.

Hugs to all you LTC staff!!

[bucksandra]

Please refer to Federal Tag 221. This has to do with Physical Restraints. By definition, a physical restraint is ANYTHING that is fastened to or around the Resident that prevents the Resident from rising or having NORMAL access to their body. A low chair is not a restraint Unless, the Resident cannot rise every single time and on demand. Hope this helps.

[cathy54]

There is one question I would like answered. How is a floor mat a restraint. Unless, I read it wrong, I cannot figure it out.

The BS and stupidity of management is what finally has made me want to go to Home Health. I love working geriatrics, but when common sense flies out the window, it is time to go.

[CapeCodMermaid, RN]

If you make the resident sleep on the mat instead of the bed so they can't stand up then it's a restraint. If you put a mat on the floor to prevent a serious injury if they doget out of bed, it is NOT a restraint.(just make sure it's documented and keep it off the floor when the resident or an ambulatory roomate is out of bed)

[cathy54]

This is what I mean by common sense. I totally agree that State should have to come in and work with the residents for at least a month, before passing out guidelines

[regulating and lovin]

First of all, Surveyors do not make up the "guidelines". All nurses should familiarize themselves with the rules and regs of the area they choose to work. These regs are in place to protect Residents. There are some of us that remember the elderly being tied with sheets around the waist in a wheelchair. We've come a long way. On the flip side, and yes, I've been on both sides...in some areas, we've gone to the extreme. LTC is so heavily regulated that sometimes its hard to do "whats right for your Resident." There must be assessments and a Comprehensive Plan of Care in place. Take credit for the things you've tried. More often than not, there is nothing in the chart to show that non-restricitve measures have been tried. Just keep all of this in mind.

[brendamyheart]

According to the MDS a restraint would be a 'chair that prevents rising'...doesn't say anything about slowing someone down. I would argue this one with the surveyors.

Ditto!!!!!!!!!!!!!

[brendamyheart]

This is what I mean by common sense. I totally agree that State should have to come in and work with the residents for at least a month, before passing out guidelines

I would buy tickets to see that!!

[brendamyheart]

If you make the resident sleep on the mat instead of the bed so they can't stand up then it's a restraint. If you put a mat on the floor to prevent a serious injury if they doget out of bed, it is NOT a restraint.(just make sure it's documented and keep it off the floor when the resident or an ambulatory roomate is out of bed)

Did you know if a resident falls of the mat, it is considered a fall!!!!!!!!!

[morte, LPN, LVN]

i can understand the mats being a restraint, if the patient is minimally ambulatory...and they try to walk on the mat and cant.....esp in the places that use mattresses instead of high density foam mats.....i think the biggest issue is documenting the non ambulatory status....and yes, somewhere along the line it changed and now if they roll onto the mat it is considered a fall;---if they are in a low bed- it makes no @#%@ sense to me.

[nightmare, RN]

We have exactly the same problems,we use bed rails to protect an epileptic lady from falling out of bed when she has a seizure.She is not physically able to get out of bed but it is seen as a restraint.We have a temporary care plan which is signed daily stating that the bed rails are for protection only.When we put bumpers on the bed rails to prevent her from injuring herself while having a seizure the commission said we were restricting her vision and isolating her! You really can't do good for doing bad in this job!

[withasmilelpn]

Please refer to Federal Tag 221. This has to do with Physical Restraints. By definition, a physical restraint is ANYTHING that is fastened to or around the Resident that prevents the Resident from rising or having NORMAL access to their body. A low chair is not a restraint Unless, the Resident cannot rise every single time and on demand. Hope this helps.

Yes I really want the low chair to act as a restraint truthfully for my residents who think they can walk but can not. Do they actually? They haven't made a chair that can keep them from doing anything. It hopefully slows them down enough so that when their alarm sounds and I am at the end of the hall I may make it in time to prevent the skin tear, bruise, broken hip or amazingly nothing but paperwork, paperwork, paperwork scenario that happens again and again. Yes I understand all the interventions and documentation required and I am dutiful in this respect. Only one on one is truly effective and who has that staff? And what about the poor, sweet lady that beats you when you try to prevent her from killing herself? Often times I'll take the person with me while I pass meds. Then I'm out of compliance with my med pass times, right, but what else is new? Can't win!