Limiting Physical Restraint Use

This tool calculates your restraint rates in a convenient Excel file. Enter in your monthly data and this spreadsheet will automatically calculate the % in comparison to the total # of residents at the home, as well as YTD, and produces 2 visual graphs that will show progress over time.

Be sure to click on the “instructions” tab before you begin.

This tool, which replaces the previous Restraint and/or Enabler Flow chart and the Side Rail/Alternative Decision Tree, provides a step by step criteria for determining a device’s effect on a resident.

CMS’ rewrite of F323 "Accidents" about death caused by devices is also incorporated into this tool.

Download the updated Primaris “Making the Right Choice” brochure that provides easy-to-understand facts about restraints for residents and families. Choose from the black and white (1st file at right) or color version (2nd file at right). Then, print as a two-sided document to have a two-page handout.

You might choose to include this brochure as a helpful resource in your admission packet along with “Safety Without Restraints: Fall and Restraint Facts for Residents and Families.”

This tool helps assess a resident's fall risk factors over time based on categories such as mental status, mobility and medical history. A checklist system allows for easy identification of risk factors and a gradient scale characterizes each risk from low to high.

Following assessment, refer to this chart for suggested interventions to avoid restraints utilization and/or reduce falls. This chart is divided into the following intervention categories, review each section for interventions specific to each resident:

• Resident Interventions
• Family Interventions
• Environmental Interventions
• Staff Interventions

Lawsuits are being won for harmful outcomes from using restraints; but fewer and fewer are won for harmful outcomes from non-use of restraints.

This document provides an overview of some of the defenses, arguments and legal interests around restraint use and falls. Please note that this material for informational purposes only; Primaris does not provide legal advice. Please consult an attorney before taking any legal action regarding the issues discussed here.

This handout for residents and patients from the American Geriatrics Society describes three simple exercises for improving balance.

Download and print this manual for a comprehensive look at individual seating – identifying a person’s body contours, range of motion, orientation in space – and implementing a seating system that best positions and supports the person for comfort and function.

This assessment should be completed at the following intervals for follow up for all falls. A fall that is unwitnessed, or in which the head is struck, requires neurological checks. Any change in resident condition requires a phone call to the primary care physician.

This flyer for residents and families highlights a personal story – one daughter’s conflicting desire to respect her mother’s desire for independence while keeping her safe from falls. It also provides a brief review of prominent research outlining the risks of restraints, including bed side rails. Print as a two-sided page to have a one-page handout.

Use this log to document resident falls in a facility over the course of one month.

Analysis of the fall investigation will assist your facility and the care team take steps to prevent recurrence of falls.

Refer to this document to implement focused activities for residents who are agitated.

Use this document to assess and evaluate the use of physical restraints.

Use this flow chart to go through the key steps and key elements for restraint elimination.

This document outlines exercises that can be performed as part of an activity program or restorative nursing program.

Use this sample policy to identify residents at risk, assess residents and implement a fall prevention program.

The tool was developed to assist providers in collecting and analyzing data consistent with performance improvement efforts.

This checklist should be completed at intervals for follow up for all unwitnessed falls or falls in which head is struck. Any change in resident condition requires a phone call to the primary care physician. Updated July 2009

The Morse Fall Scale (MFS) is a rapid and simple method of assessing a resident’s likelihood of falling. The MFS is used widely in acute care settings.

A systems assessment is a starting point for a quality improvement project. These checklists will help you evaluate your practices regarding restraint use and elimination. Checklists guide you though evaluating the following components: Organizational Commitment to Elimination; Resident Assessment; MDS Coding; Developing Care Plans; Elimination; Training and Education.