Directions For Using the Ohio Department of Health Physical Restraint Decision Tree

Preparation

Prior to using the Physical Restraint Decision Tree (PRDT) it is important that the user read the information provided on pages five and six of the folder. Also review the definitions for physical restraints and freedom of movement located on page 3 of the PRDT. The information will assist in determining the appropriate response to questions contained in the PRDT.

A determination of whether a device is or is not a restraint is based on an individualized comprehensive assessment of the particular resident. The use of any device requires ongoing assessments of the use of the device and the impact the device has on the resident.

Purpose

The PRDT will assist in identifying whether a device is an enabler, an enabler that is also a restraint, a restraint, or whether the device is not included in those delineated categories. The PRDT also provides information about actions that must be taken to meet regulatory requirements and standards of practice when a device is determined to be an enabler, an enabler that is also a restraint or a restraint.

Devices that do not restrict movement and do not improve functional status fall outside the parameters of the PRDT. Facilities should re-evaluate the need for the use of the device, document the reason for the use and reference on the plan of care (POC) as appropriate. Facilities should follow acceptable standards of practice for the use of the device for the specific resident.

I. Initial Analysis

Directions:

Begin the analysis by determining the response to the questions in the box labeled "Initial Analysis" located at the top of page 2 of the PRDT following the "Start" arrow as the questions relate to the particular resident.

Consider the following:

• Why is the device necessary for the care of the particular resident?
• What are the symptoms causing the need for the device?
• What impact will the device have on the resident?

Directions:

After the initial analysis questions have been answered proceed to the "Decision Making" arrow located under the "Initial Analysis" box at the top of page 3.

II. Decision Making

Directions:

Answer the questions on the PRDT following the decision making arrow and then follow the arrow that corresponds to the answer to the question, i.e, "yes" or "no". Continue to answer questions and follow the directional arrows corresponding to the answers until a "stop" sign is reached.

III. Information

The following is information and factors that are to be considered in answering the questions in the decision making section of the PRDT.

Question: Does the device restrict a resident's freedom of movement?

• Determine the actions that the resident is capable of performing.
• Determine how and when the device is removed by or for the resident.
• Determine whether the device prevents the resident from performing a movement that they would otherwise be capable of performing.

Question: Does the device assist in the improvement of the resident's functional status?

• Consider whether the device allows the resident to do something that would improve their quality of life.
• Consider whether the device allows the resident to participate in an activity in which they would otherwise not be able to participate.
• Consider whether the device improves physical or emotional status.
• Determine if there is a medical symptom for the use of the device. The medical symptom for an enabler or enabler that is also a restraint will be the reason that the device is required to improve the resident's functional status.

If you have concluded that the device restrict a resident's freedom of movement and does not improve the resident's functional status review the following.

Question: Is the device imposed for purposes of discipline or staff's convenience?

• The use of a device in this case is never allowed.
• The restraint of wanderers, confused residents, etc., due to lack of sufficient facility staff to supervise is considered use of a device for staff's convenience or discipline and is not allowed.

Question: Is the device used to treat medical symptoms?

• Identify the reason for the use of the device.
• Restraints may only be used for the amount of time as is necessary to treat the medical symptoms.

Question: Was the device requested by an alert resident?

• If an alert resident requests a restraint that is not required to treat medical symptoms, the facility must evaluate the reason that the resident wants the restraint, and develop a plan of care based on that assessment.

IV. Conclusion

If the device is an enabler, document reason for use and reference on POC. Follow the restraint protocol on page 4 of the folder when it is determined that the device is an enabler that is also a restraint or a restraint.

Last updated: 5/1/00