| Restraint
Use and Compliance with federal regulations
may be monitored as a quality assurance activity.
When there is deviation from an acceptable threshold
of compliance, the process of seeking improvement
should include the following problem-solving
techniques:
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Problem-solving
Techniques |
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Plan |
- Determine the extent of the problem.
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- Brainstorm with staff to determine the most
likely reasons for the
problem.
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- Develop a plan to address the problem (e.g.,
staff education, schedule
changes, activities, policy
and procedure change).
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- Decide how the response to the improvement activity
will be tracked.
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Do
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- Educate staff, families and residents.
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Study |
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Act |
- Revise
the plan as needed
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- Continue
to track response
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| As
retraint reduction proceeds and is maintained,
falls and injuries should also be evaluated.
Falls and injuries should be monitored,
including the number, times of day, location,
and causes. An increase in falls warrants
an assessment of the incident reports and
post-fall assessments to determine the reason
why the residents fell, so that necessary
revisions in individual plans as well as
operational plans may be made. |
Use
of Quality Indicators |
| Since
June 1998, all long-term care facilities
are mandated to electronically transmit
resident assessment information contained
in the MDS. This information is collated
into quality indicators used by state
surveyors to: |
| 1) |
monitor
the quality of care to identify residents
that should be reviewed during
the survey process, |
| 2) |
identify potential problems within
a facility and, |
| 3) |
identify potential problem facilities.
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The
Quality Indicator related to
Restraint Use is QI 26, categorized
with prevalence of "little or no activity"
in Domain 10: Quality of Life.
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Sample
of QI Report for
Restraints |
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#
in
Num. |
#
in
Denom.
|
Facility
% |
Comparison
Group |
Percentile
Rank |
Quality
of Life
22. Prevalence of daily physical restraints |
7 |
177 |
4.0 |
8.7 |
13 |
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Interpretation: |
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" # in Num."
is the total number of residents
in the facility that are restrained
on a
daily basis at most recent assessment.
" # in Denom."
is the total number of residents
in the facility at most recent
assessment .
Facility % is the
percentage of the facility residents
that are restrained on a daily
basis. ( 7 divided by 177.)
Comparison group
- reflects similar facilities' performance.
Percentile Rank
- reflects the facility's performance
versus that of other facilities
in the state- homes of similar size
and level of care.
If
percentile rank is high, surveyors
will ask staff to address concerns
about this indicator.
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The
quality indicators can be a useful
tool to track progress toward restraint
reduction and assess resident functional
outcomes, as well as related outcomes
(e.g., use of psychoactive medication
and time involved in activities),
in response to these changes. The
following are useful parameters
to monitor:
1)
Facility percent number should be
tracked as the facility continues
to reduce the number of restraints.
2) Facility may compare itself to
its comparison group and percentile
rank.
3) Composite functional status and
outcomes of restrained residents
may be tracked. Analysis of this
data may suggest program changes,
such as increased activities or
a urinary incontinence program.
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