1. MONTANA DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES Quality Assurance Division Licensure Bureau 2401 Colonial Drive 2 nd Floor P.O. Box 202953 Helena, Montana 59620-2953 (406) 444-2676 ARM Title 37, Chapter 29 Restraints, Safety Devices, Assistive Devices & Postural Supports in Assisted Living Facilities

2. SAFETY vs. RESTRAINT What is the difference? Why is it important?

3. Its the Law October 1, 2001 50-5-226 (a) MCA: The (assisted living) resident may not require physical or chemical restraint or confinement in locked quarters, but may consent to the use of safety devices pursuant to Title 50, chapter 5, part 12.

4. 50-5-1201 MCA Use of Safety Devices-request & consent-allowed individuals Who can request? A resident, family member of a resident who is unable to make decisions because of communication barrier, or found by a physician to be medically incapable of granting informed consent, Guardian Person granted power of attorney for health care decisions.

5. When can a request be made? When there is a concern for a residents physical safety, When a residents fear of falling is such that an intervention is required.

6. Then what? The resident and/or representative can request and consent in writing for the use of a safety device. HOWEVER: the request is not intended to interfere with the right of licensed health care providers acting within their scope of practice.

7. 50-5-1203 MCA Procedures-informed consent- physician involvement Upon receipt of request for use of a safety device, the facility shall inform the requestor of the alternatives and risks associated with the use of the safety device. A signed consent form authorizing its use and acknowledging receipt of specific information about available alternatives and risks.

8. 50-5-1203 MCA Procedures-informed consent- physician involvement A written order from the attending physician that specifies the circumstances under and the duration for which the device may be used and the medical symptoms being addressed. The above does not apply to a side rail or other device used only as an assistive device and does not restrict the residents movement from bed or chair.

9. BUT WHY THIS LAW?

10. FDA Safety Alert: Entrapment Hazards: Bed Side Rails Dated August 23, 1995 Since January 1990 FDA received 102 reports of head and body entrapment incidents involving bedside rails. 68 deaths, 22 injuries and 12 entrapments. UK, Canada and other sources received similar reports.

11. FDA Safety Alert: Entrapment Hazards: Bed Side Rails All reported entrapments in one of the following ways: 1.Through the bars of an individual side rail; 2.Through the space between split side rails 3.Between the side rail and the mattress 4.Between the headboard or footboard, side rail, and mattress

12. What is the difference? Restraint any method (chemical or physical) of restricting a persons freedom of movement – prevents independent & purposeful functioning: Seclusion, controlling physical activity, restricting normal access to the residents body that is not part of a consented medical diagnostic or treatment procedure ARM 37.106.2902 (5) Safety device means side rails, tray tables, seat belts, or other similar devices used to maximize independence & maintain health & safety by reducing the risk of falls and injuries associated with medical symptom/s. ARM 37.106.2902 (6)

13. ARM 37.106.2904 Use of Safety Devices, Assistive Devices & Postural Supports *Remember Restraints are not allowed in Assisted Living Facilities *May not be used for purposes of coercion, retaliation, discipline or staff convenience.

14. ARM 37.106.2904 Use of Safety Devices, Assistive Devices & Postural Supports *ARM 37.106.2904 (5) Single or two quarter bed rails that extend the entire length of the bed are prohibited. *A bedrail that extends from the head to half the length used for safety or assistive device is allowed. (how weak is the resident? Can they become entrapped?)

15. *ARM 37.106.2904 (6) orthopedic devices or postural supports are not considered Physician prescribed to be safety devices and are not subject to the requirements for safety devices. *ARM 37.106.2904 (7) Whenever a safety device or postural device is used that restricts or prevents a resident from independent and purposeful functioning, the resident must be provided the opportunity for exercise & elimination needs at least every two hours, or more often as needed, except when sleeping.

16. *ARM 37.106.2904 (8) All methods of safety devices, assistive devices and postural supports must be properly fastened or applied & permits rapid removal by staff in the event of fire or emergencies.

17. ARM 37.106.2905 Documentation A consent form signed by the resident or authorized representative that includes: That a written explanation of the alternatives and known risks associated with the use of the device was received. Identifies the pre-existing conditions that may place the resident at risk for injury (such as a stroke, blindness, etc.)

18. ARM 37.106.2905 Documentation A Written authorization from the residents primary physician that specifies: The medical symptom that the safety device is intended. The type of circumstances And the duration to be used

19. ARM 37.106.2905 (2) Documentation When a safety device is used the following must be documented in the resident record: (a)frequency of monitoring according to facility policy. (b)assessment and provision of treatment if necessary for skin care, circulation, and range of motion. (c) any unusual occurrences or problems

20. ARM 37.106.2905 (3) Documentation During a quarterly evaluation the facility must consider: That the least restrictive safety device is being used (what other alternatives have been tried, could be tried?). What causes the medical symptoms? (weakness from illness, stroke, etc) Alternative safety measures if the safety device is removed. If removed, done so with the resident or resident representative and attending physicians consultation.

21. ARM 37.106.2908 Staff Training Safety devices or postural supports may only be applied by staff who have received training in the format of information and demonstration in : The proper techniques for applying and monitoring Skin care to prevent redness, breakdown and decubiti. Active and passive assisted range of motion to prevent joint contractures

22. ARM 37.106.2908 Staff Training Assessment of blood circulation Turning and positioning to prevent skin breakdown and keep lungs clear. Potential risk for injury or asphyxiated because of entanglement or mattress entrapment. Provision of sufficient bed clothing and body covering (modesty and warmth)

23. ARM 37.106.2908 Staff Training Additional attention to meet the physical, mental, emotional, and social needs Techniques to identify behavioral symptoms that may trigger the need for a safety device: Observing intensity, duration, and frequency of behavior Identify patterns over a period of time and factors that may trigger behavior

24. ARM 37.106.2908 Staff Training Is the behavior new or is there prior history? Is the behavior the result of mental, emotional, or physical illness Or is the behavior a radical departure from the residents normal personality. Training and refresher courses must be provided by a licensed health care professional or social worker with experience in caring for the elderly population.

25. ARM 37.106.2908 Staff Training Training must be provided at least annually. Training must be documented with a description of the content, who attended and the date of the training. This record must be maintained by the facility for two years.

26. Safety Device Packet The Informed Consent Information and forms are located on the Internet at: http://www.dphhs.state.mt.us/services/applications_for ms/safety_device_packet.htm Or http://www.dphhs.state.mt.us Under SERVICES select Application and Forms Then select Assisted Living/Personal Care Packet