Nursing Home Quality Improvement Initiative
Quality Measure Fact Sheet:
Percent of Chronic-Care Residents Who were Physically Restrained
What this means:
This measure reflects the percent of chronic/long term care residents who were physically restrained on a daily basis for the 7 day assessment period with any device, material or equipment attached or adjacent to a resident's body that prevents a resident from moving freely. Some examples are: vests, chairs with lap trays, lap belts, or wrist restraints. Side rails are not included in the calculation of the measure.
Why residents may have restraints as part of their care:
The use of restraints should be strictly limited to cases where restraints are needed in order to treat the resident's medical condition, and only if the restraint will assist the resident in reaching a higher level of functioning. The restraints must be ordered by a physician. They are not used to punish a resident or for staff convenience. Restrained residents may develop pressure sores, lose the ability to go to the bathroom independently, or become sad or depressed. In some cases, residents have suffered severe injury or even death while restrained.
Examples of appropriate restraint use may include the following:
- Using a restraint for several days to allow a confused resident to receive essential intravenous fluids or medications.
- Using positioning devices such as special seat cushions that help the resident to sit properly but that may not allow the resident to get up without help.
What conditions exclude a resident from this measure: (Risk adjustment)
No conditions are excluded from this measure.
| Questions you can ask the facility if they are rated high in this measure:
- How does the facility decide when restraints are needed, or decide that less restrictive alternatives are not workable?
- How does a facility determine whether a patient's restraints are still necessary?
- How does the facility know the restraint's doing what it's supposed to do, and watch for complications?
- Does the facility have a restraint reduction program or policy?
- Does the staff help the restrained resident move as much as is practical?
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