now considered a restraint?

[ktwlpn, LPN]

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....

[bargainhound, RN]

Sounds like impossible situation.

What do they suggest?

How would they solve the issues?

I know inspectors sometimes give mandates and apologize but

still say "whatever" must be done.

I do not have the answer.

The unreasonable rules/threats from inspectors did me in, I could

not cope. I thought it was not possible to do what the asked

and they let us know they were out to get all of us (all NH

mgrs,etc. at a state conference)........seems insane to me.

[curiousauntie]

I had a state survayor tell me that a one piece jumpsuit with a zipper in the back with a velcro cover over the zipper pull was a restraint...because it stopped the resident from taking off her cloths. If we didn't use it she would have said that we were not protecting the residents dignity. When asked how she wanted us to stop the resident from stripping every 5 minutes or less (that figure is documented), she said that she was not there to provide the answers, but to point out our wrong doing. She cited us, but the DON and Administrator fought it with her supervisor and it was thrown out.

[dekatn]

This is one reason I had to get completely out of LTC. Too much BS.

[CapeCodMermaid, RN]

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.

[withasmilelpn]

At an old facility I worked at a resident I had fidgited constantly until she scooted out of any chair we put her in. We finally hit on a bean bag chair which worked great. State came in said undignified and out went the chair and back she went to falling. Sometimes I wish they would be forced to take care of even just 5 people like this for a week and see what they would come up with!

[purplemania, BSN, RN]

I would argue that any chair has the potential to be a restraint if you set a patient in it who is known not to be able to get up without assistance. The furniture is not as important as the intent. For instance, some patients request the lap trays that lock on their chairs so they can play cards or eat or do puzzles. But it is not a restraint in that sense, since the intent was to oblige the patient, not restrict movement. That is my two cents.

[meownsmile, BSN, RN]

Hospitals are getting the same thing. We cant use geri chairs anymore because they are a type of restraint. Our ortho patients need them because of them being higher than the regular chairs and being more able to rise from the chair with the walker. Go figure, next the bed alerts that switch on the call light will be an invasion of privacy and we wont be able to use those either.

[withasmilelpn]

Well then we need to go back to being facilities that are not designated 'restraint-free', because some people quite frankly need them in order for us to keep them safe. I know the dangers, we just need to have access to whatever minimal amount of restraint is needed. There is just not enough staff to monitor these people. A chair should not be too much to ask!

[CapeCodMermaid, RN]

It all has to do with proper documentation. If someone is non-ambulatory,a gerichair/recliner is NOT a restraint. If they were sitting in a regular chair, they would not be able to get up and walk, so putting them in a recliner does NOT prevent that. If a resident wants a tray table to play cards on or do puzzles on, that does not make it a restraint IF it is documented. We are allowed to use restraints when clinically necessary. Remember to document the clinical reason a restraint is used. Include all the other interventions you tried BEFORE you started using the restraint....have an MD order and include restraint free times. .. put it in the care plan and you should be okay.

[dragonflyRN]

I agree, to a point. The state's do say it's a restraint, regardless of documentation.

[caliotter3]

When I was working LTC as a new CNA, centuries ago, we were required to have all bed rails up for safety. I left for a little while and came back when I got my license. We were getting ready for the survey; a consultant (former DON of that facility who had moved up in the company) explained to me that the rails had to be down, unless ordered up by the MD, b/c they were considered a restraint. I told her that I thought that it didn't make sense, that one day we're talking safety, the next we're talking restraint, concerning opposite behavior.