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Ask the Expert: Restraint use coded on MDS

Q: We have had residents who are inmates of the sheriff’s depart.  Because of being in the custody of the sheriff’s department the resident has to be handcuffed to the bed or w/c at all times.  They usually are not in restraints due to the facilities policies, but due to sheriff’s department policy.  How should this be coded on the MDS?  Is it considered a restraint?

A:  The unusual situation you describe is not addressed in the MDS User’s Manual.  However, the handcuffs definitely meet the definition of a limb restraint.  In the MDS User¹s Manual on page P-3, review the steps for assessment and clarifications.

  • Considering the physical restraint definition as well as the clarifications listed below, observe the resident to determine the effect the restraint has on the resident¹s normal function. Do not focus on the type, intent, or reason behind its use.
  •  Evaluate whether the resident can easily and voluntarily remove any manual method or physical or mechanical device, material, or equipment attached or adjacent to his or her body. If the resident cannot easily and voluntarily do this, continue with the assessment to determine whether or not the manual method or physical or mechanical device, material or equipment restrict freedom of movement or restrict the resident¹s access to his or her own body.

Also check ŒUnder Coding Tips and Special Populations.¹ Although this does not fit perfectly, it will help with care planning and justification:

Restraints used in emergency situations. If the resident needs emergency care, physical restraints may be used for brief periods to permit medical treatment to proceed, unless the resident or legal representative has previously made a valid refusal of the treatment in question. The resident’s right to participate in care planning and the right to refuse treatment are addressed at 42 CFR §§483.10(b)(4) and 483.20(k)(2)(ii) respectively. The use of physical restraints in this instance should be limited to preventing the resident from interfering with life-sustaining procedures only and not for routine care.

A resident who is injuring himself/herself or is threatening physical harm to others may be physically restrained in an emergency to safeguard the resident and others. A resident whose unanticipated violent or aggressive behavior places him/her or others in imminent danger does not have the right to refuse the use of physical restraints, as long as those restraints are used as a last resort to protect the safety of the resident or others and use is limited to the immediate episode.