So many times, we code this section of the MDS and penalize ourselves. This section is one of the easiest to code incorrectly. (Read More to find out how to correctly code this section.

What is a restraint?

• Physical restraints are defined as “any manual method, physical or mechanical device, material, or equipment attached or adjacent to the resident’s body that the individual cannot remove easily that restricts freedom of movement or normal access to one’s body.”

To correctly code this section the reviewer must look at each of the following closely:

1. Is the resident able to remove the device or get out of-- or away from-- the situation or method in use without help?
2. Does the device or method help the resident to change position safely or without assistance?
3. Does the device allow the resident to have free access to his/her body?
4. Does the device allow the resident an unobstructed view of their environment?
5. Is the resident unable to get themselves from their bed or chair without help? (i.e. is the resident immobile or lacking voluntary movement?)

If the answers to these questions are "yes", the device or method in use is probably not a restraint and should not be coded as such.

Why is this important?
According to the Code of Federal Regulation CFR at 42 CFR 483.13(a), “The resident has the right to be free from any physical or chemical restraints imposed for the purposes of discipline or convenience and not required to treat the resident’s medical symptoms.”

No resident should ever be restrained for discipline or staff convenience. Prior to using any restraint, the nursing facility must perform a prescribed resident assessment to properly identify the resident’s needs and the medical symptom the restraint is being used to treat.

If a restraint is necessary, the facility should continually review its use and try to gradually reduce and eliminate it.

Coding this area takes true assessment of the device or method being used and the effects that restraining movement can bring forth in our residents (e.g. undue stress, depression, self injury, and increase in anxiety and aggression.) We must always look for ways that we can improve the quality of life of residents and ridding them of unnecessary devices can be one of those ways.