It is OK to use a therapeutic device when a health professional like a doctor or occupational therapist has approved it. The person with disability also needs to say it is OK. Both definitions relate to behaviour and if being used in this way they meet the definition of restrictive practice. So, when is a pelvic belt a restraint and when is it an enabler…?
We know that there are facilities out there that have very stringent restrictive practice policies that continue to impact on the prescription of a therapeutic support.
It is still crucial that if you have identified the need for a positioning support, that you own it! Best practice indicates that you still make the recommendation and document the reasons how it will enhance function. If you want more information on positioning supports, we offer educational workshops on seating and positioning and are always available to help you.
Feel free to contact me at tracee-lee. Tracee-lee Maginnity Clinical Education Specialist. She graduated Auckland University of Technology with a BHSc Occupational Therapy in and has since worked in various roles related to seating and mobility including assessing, prescribing and educating. Tracee-lee is passionate about maximising functional outcomes with end users and the importance of education within the industry. Toggle navigation. Register Log in Shopping cart 0 Shopping cart 0 You have no items in your shopping cart.
Blog archive. August 5. September 4. October 4. November 4. December 3. February 4. March 3. April 6. This includes personal restraint, physical restraint, environmental restraint and seclusion. The use of restraint is a clinical decision and has significant legal and ethical implications. Family may support the decision, but cannot approve or request the use of an enabler without the consent of the consumer. The instrument subsequently was modified to achieve face and content validity.
In Phase Two, the revised questionnaire was sent to 19 long-term care facilities. All completed and returned the questionnaire. Survey results indicated a lack of understanding among more than half of the respondents regarding the OBRA regulations that address when a bedrail is considered a restraint or enabler as well as lack of understanding with respect to documentation to support bedrail use. The majority of the respondents who stated they understood the definitions of bedrails as restraints and enablers did not present interview data to support comprehension of their correct implementation.
Survey administration. Names of nursing homes were obtained from the Medicare. Questionnaires were similar for both groups. For example, nursing home directors were asked if they had received a deficiency citation for bedrail use in the past year and if yes, to stipulate the reason for the citation. State surveyors were asked if they had issued a deficiency citation for bedrail use in the past year and, if so, the reason for the citation.
Additional questions addressed the use of bedrails as restraints or enablers, documentation and policies for these uses, and personal understanding of the OBRA regulations for bedrails. Data analysis. Data were analyzed with SPSS Frequency of item response was calculated for each question and t -tests were used to compare differences between groups.
All states were coded and used as a variable for analysis of response. Reasons for not returning the questionnaires included not using side rails in the facility and a general unwillingness to participate.
Of the 39 participating states, 26 returned two questionnaires and 13 returned one questionnaire. Bedrail citations.
All of those receiving a citation said it was for using bedrails as a restraint, with half reporting inadequate documentation. Of these, Directors of Nursing. State surveyors.
Appropriate reasons included: alternative more restrictive State surveyors responded that they understood OBRA regulations regarding bedrails as restraints Comparison of significant differences in responses see Table 1. Significantly more SSs said bedrail use was appropriate as an enabler to assist with movement, at the resident's request, if the alternative was more restrictive, and for immobility problems.
Significantly more DONs than SSs said bedrails could be used as a restraint at the physicians' or families' request to prevent movement out of bed. Differences in documentation requirements for bedrail use also were noted. Significantly more SSs felt documentation as an enabler should be included in an interdisciplinary plan of care and the resident response implemented. When bedrails are used as restraints, surveyors said a multidisciplinary plan of care, alternative intervention, a physician order, informed consent, and resident response implemented were appropriate documentation at significantly higher response levels.
Historically, restraints have been used because elderly people, especially frail elderly, were believed to be at risk for falls and injury if they were not restrained. These assumed safety benefits have been called into question with regard to quality-of-life issues. Until recently, only a few studies have examined bedrails as a form of restraint, their risks and benefits, psychological and demobilization effects of confinement, the documentation required to avoid deficiency citations, and outcomes of bedrail reduction in long-term care facilities.
One strategy has been simply to stop using any bedrails and place the mattress on the floor if a resident is thought to be at risk for falling out of bed. Facilitating movement in bed is important to reduce the risk of pressure ulcer development. On the other hand, preventing injuries due to falling or incontinent episodes because of interference with the ability to get out of bed is also a crucial consideration.
Consequently, long-term care facilities are caught between the need for and the misuse of bedrails. Results of this study showed a generalized acceptance of bedrail use as an enabler but not as a restraint by both DONs in long-term care facilities and SSs.
The problem both sides are facing is the lack of congruence in appropriate reasons for bedrail use and the supportive documentation necessary.
Directors of Nursing were not sure when bedrail use was appropriate, even as an enabler, and were uncertain as to how to document bedrail use to avoid citations.
State surveyors indicated that a resident's request and the need to have assistance with movement were reasons bedrails could be used as enablers and that this could be documented in a multidisciplinary plan of care for the resident. By requesting individual assessment and planning for restraints or alternatives to restraints through the use of an interdisciplinary team - and with input from the resident and family or the patient's legal guardian - this can be accomplished.
This practice is based on both positive and negative outcomes of the decisions being discussed and documented by all parties. Another area of confusion involves classification of the device as a restraint or enabler. The assessment is to consider, "the effect the device has on the individual - not the purpose or intent of its use. It is possible for a device to improve resident mobility and also have the effect of restraining the individual. If the side rail has the effect of restraining the resident, the facility is responsible to assess the appropriateness of the restraint.
Several limitations were identified in this study. First, the term enabler as used in this study is not used in government policies or documents but is a generic term to denote alternative use of a bedrail in some way other than as a restrictive device. Also, not all states participated in this study and a larger survey of state regulators and long-term care facilities needs to be undertaken before policy decisions on appropriate documentation and use of bedrails can be achieved.
Current regulations are flexible enough that individualized interpretation by SSs and confusion between the intent of OBRA and the daily operations of nursing homes are prevalent. A balance needs to be found between use and non-use of bedrails. This can only be accomplished by fully informing residents and families - as well as the caregivers, administrators, and SSs - of the risks and benefits of bedrail use as either restraint or enabler. Education on bedrail use seems to be lacking. Further examination of the issue, including the development of interventions to improve knowledge and the development of policies and procedures leading to a consensus of appropriate use, is a crucial step to ensuring bedrails are used to their best advantage.
Guidance to surveyors in the implementation of 42 CFR Part Medicare and Medicaid Programs. Clinical guidance for the assessment and implementation of bed rails in hospitals, long term care facilities, and home care settings.
Available at: www. Accessed January 5, Nursing home compare. Accessed January 5,
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