MDS Alert

Published on Wed Aug 23, 2006 PDF

To code or not to code at P4.

Which of the following examples describe scenarios where you'd code a a restraint in Section P4?

Example No. 1: The resident is transferred from her wheelchair to a regular chair for meals.

The resident is not able to push the regular chair under the table or away from the table and must be assisted by staff in order to leave when finished. (The resident is not able to get out of her wheelchair or other chair without assistance.) Is the regular chair a restraint?

Example No. 2: A resident with Parkinson's disease cannot walk independently. He asks to use a framed wheeled walker because this allows him to leave the unit and walk independently around the facility visiting his friends. He is unable to open the front of the device and exit on his own and must have staff do this for him when he wants to get out of the walker. Is this device a restraint?

Example No. 3: A resident with Alzheimer's dementia had a fall and fractured his ankles. Surgery was done and now the resident needs to be non-weight-bearing for a period of time.

The resident wheels himself around the facility in a wheelchair but does not remember that he cannot stand or walk and has a seat belt on to keep him from getting up. The resident cannot release the belt when asked to do so. Is this device a restraint?

Source: The above examples and answers were provided courtesy of Residential Care Services, a unit of Aging and Disabilities Services Administration for Washington State.

ANSWER:

Example No. 1: No. The resident's condition (rather than the chair) is preventing her from getting out of the chair. 

Example No. 2: Yes. According to the RAI manual, on page 3-200, if the resident cannot easily open the front gate and exit the device, code it as a restraint for this resident (at P4e - chair prevents rising). Facilities should also code the device at G5a (cane/walker/crutch) as long as the resident used it to walk during the seven-day observation period.

Example No. 3: Yes. The seat belt meets the definition of a restraint because it restricts freedom of movement and is not easily removable by the resident. This would be coded at P4c.