This text based course is a transcript of the live webinar titled, "Restraint Reduction: Regulations, Alternatives and Therapy Intervention" presented by Kathleen Weissberg MS, OTR/L.
>> Kathleen Weissberg: Our objectives for today are to discuss regulations and state survey guidelines related to restraint use. We are going to talk about occupational therapy's role in restraint reduction and we are going to go through assessment. We will also look at intervention and some alternatives for restraint use for falls and behavior related issues toward the end.
State Survey Guidelines
Let’s start looking at the state survey guidelines. Restraint reduction is a critical area that directly impacts resident quality care, with the common goal of enhancing quality of life. The OBRA, which is the Omnibus Budget Reconciliation Act of 1988, the mandate goes to state surveyors and it recognizes the detrimental effects of restraint usage. The survey guidelines state and I quote
“The resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident’s medical symptoms.”
It goes on to say,
“It is expected that for those residents whose care plans indicate the need for restraints that the facility engage in a systematic and gradual process toward reducing restraints, meaning they gradually increase the time frame for ambulation and muscle strengthening activities."
That comes directly from tags F221 and F222 from the state survey guideline. Before I go on, I want to make the comment that it does say in there “least restrictive environment.” Therefore we are required to provide the residents with least restrictive devices or environments, not restraint free.
Most places right now are restraint free to a large degree, but they do not have to be. It just has to show that we are moving toward the least restrictive. This might include environmental modification or modifying the resident’s daily routine. Again per the survey guidelines,
“the facility must design its interventions not only to minimize or eliminate the medical symptom, but also to identify and address any underlying problems causing the medical symptom.”
We really need to investigate all the reasons why we might be using a restraint. We see restraints most commonly in a long-term care facility, though we might see them in the hospital environment as well. It is the responsibility of the facility's interdisciplinary team to maintain the resident at his or her highest level of function and maintain them as safely as possible.