Reducing Restraints in Nursing Homes

This project is intended to substantially lower the usage of physical restraints in participating nursing homes.

As the project progresses, we will post status updates, lessons learned, and useful tools to this webpage.

Measures
Project success will be tracked using a measure already collected and reported by all Medicare-certified nursing homes nationwide:

The percent of long-stay residents who were physically restrained in the last seven days.

(This measure is part of the MDS, or minimum data set, required by Medicare. Results are published on the Nursing Home Compare website. See more details about this measure.)

Device Decision Tool
Person-centered care involves re-examining the treatments provided to each individual. Use this flowchart to determine whether a particular device is actually a restraint, an enabler, or a safety hazard for an individual resident.

Minimum Data Set (MDS) version 3.0
The final version of MDS 3.0 is scheduled to be published in October 2009, with implementation by October 2010. See the related details on the CMS website as well as a whitepaper from the American Association of Homes and Services for the Aging.

Physical Restraint Change Package
This Change Package is a living document and will be updated as successful strategies and action steps are identified to further help nursing homes reduce the use of physical restraints. It was developed by the Patient Safety QIO Support Center and was largely adapted from the Advancing Excellence in America’s Nursing Homes campaign materials.

From Institutional to Individualized Care
Many participants in the transformation from institutional to individualized care have questions regarding compliance with current regulatory guidelines. The Centers for Medicare and Medicaid Services (CMS) has created a four-part series to explore these and many other issues.

The prevention of pressure ulcers and elimination of physical restraint usage are two topics covered in the informative and detailed-filled sessions. Practitioners discuss how they have refocused basic care-giving systems, including night-time care, activity and engagement, food service, bowel and bladder functioning, and turning and repositioning.

Sessions include participants Cathie Brady, MS. Brenda Davidson, RN, Barbara Frank, MPA, Sandy Godfrey, RN, Marguerite M. McLaughlin, MA, Theresa Bennett, RN, BSN, Debora (Debit) Majo, RN, BSN, Alisa Overgaard RD, MS Pamela Riter, RN, Karen C. Schoeneman, MPA, Matthew S. Wayne, M.D., and others.

Part 1 — Integrating Individualized Care and Quality Improvement

Part 2 — Transforming Systems to Achieve Better Clinical Outcomes

Part 3 — Clinical Case Studies in Culture Change

Part 4 — The How of Change

Compilation of Restraint-Related Tools
The QualityNet website, which is maintained by Medicare Quality Improvement Organizations (QIOs) nationwide, also stores a number of useful tools and presentation recordings.

PresentationsStrategies for Reducing Physical Restraints
Session recorded 2/18/09
Two nursing homes share unique perspectives in their journey to providing quality care to their residents—free of restraints. One home shared how they recently instituted a no-restraints policy through organizational commitment; the other outlined how they’ve maintained a restraint-free nursing home while working effectively with their medical director. This is part of the Patient Safety National Call Series.

Supporting Choice and Mobility Through Restraint-Free Care
Speaker biography for Joanne Rader, RN, MN, PMNNP

Session 1 recorded 7/10/08
Handouts:  Rethinking the Use of Position Change Alarms, Four Roles Chart, and Making the Right Choice: Information for People Living in Nursing Homes & Their Families
Discusses how person-directed care leads to restraint-free care. Emphasizes how to assess three aspects of the care environment to create individualized approaches to mobility and safety that honor resident choice and wishes. The need for supportive organizational policies and procedures is addressed.

Session 2 recorded 9/10/08
Handouts:  CMS Survey & Certification Memo 07-22  and Oakview Terrace Case Study
Review of case studies, including how person-directed care leads to restraint-free care. Oakview Terrace, a nursing home in South Dakota, presents their success story and gives advice on how to become a restraint-free home.