A) Physical restraints are defined as any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident's body that he cannot remove easily which restricts freedom of movement or normal access to one's body. Chemical restraints are psychoactive drugs administered for purposes of discipline or convenience, and not required to treat the resident's medical symptoms.

B) Psychoactive drugs are drugs prescribed to control mood, mental status, or behavior.

C) Discipline is defined as any action taken by the facility for the express purpose of punishing or penalizing residents.

D) Convenience is defined as any action taken by the facility to control resident behavior or to maintain residents with the least amount of effort by the facility and not in the residents' best interest.

A) That the care of an individual should include love and concern for the person, as well as the highest level of professional care for the physical, psychological and spiritual needs; in other words, a ministry of care to the whole individual.

B) That the resident is an individual, and that he and his wishes be accepted as he makes them known. He/she is to be treated with the respect and dignity due to him/her.

C) That aging is a normal process of living and need not be a period of inevitable, physical and mental deterioration.

D) That the ultimate aim of the care process is to maintain or rehabilitate every individual in such a manner that he/she may enjoy daily living to the fullest extent of his/her actual or potential ability as related to his/her definition of "quality of life."

E) That the resident's rights, as specified in the Resident's Bill of Rights are protected and insured for each resident, especially his/her right to participate in his/her plan of care and to be free from chemical and physical restraints.

F) That the resident has not lived a risk free life prior to institutionalization and risk taking is an accepted part of living.

G) That the resident has the right to be free from restraints administered for purposes of discipline or convenience and not required to treat the resident's medical symptoms.

H) That the use of physical restraints is counter productive and their use can result in physiological changes, such as: loss of bone mass, muscle atrophy with decreased ability to walk, chronic constipation, incontinence, decubitus ulcers, and detrimental psychosocial changes such as: loss of dignity and independence, dehumanization, increased agitation, depression and/or withdrawal.

I) That the use of physical restraints as an environmental protective measure can be replaced by more creative, humane methods to safeguard the resident's well-being and that of others, including: alarmed doors, surveillance by all staff members, visual cues/deterrents, etc.

J) That the use of physical restraints is not proven more effective in preventing serious injury to residents.

K) That physical restraints may only be used for brief periods, if necessary, to provide lifesaving treatment, to protect the resident or others from physically abusive/destructive behavior of the resident, or to enable and promote greater functional independence when other less restrictive measures have failed, and then only as outlined in the procedure that follows.

L) That the resident or his legal representative must consent prior to the use of physical restraints except in cases of life threatening medical symptoms such as dehydration, electrolyte imbalance, and urinary blockage.

M) That psychoactive medication should be administered only when required to treat the resident's condition, not for purposes of discipline or convenience.

N) That the unnecessary/prolonged use of psychoactive medications can lead to extinguishing the resident's normal affect, excessive immobility leading to decubitus and contractures, and inability of resident to function at his/her optimal level.

O) That any restraint should be used only after comprehensive assessment, including an evaluation of less restrictive methods to manage the resident's problem.

A) Examples of physical restraints are: leg restraints, arm restraints, hand mitts, soft ties or vests, wheelchair safety bars and geri-chairs.

B) If after a trial of less restrictive measures and consultation with occupational therapy and physical therapy, it is decided that a physical restraint would enable and promote greater functional independence, then the use of such must be explained to the resident, family member or designated representative, prior to implementation.

C) Such explanation may be given by the attending physician or Nursing Supervisor, and must be documented in the resident's medical record. Consent to use of the physical restraint by the resident, family member or designated representative must also be documented in the medical record.

D) In the event that the resident, family member or designated representative does not consent to the use of a physical restraint as an enabler, the medical record must show documentation of such, and reflect ongoing periodic monitoring of the resident's safety and functional status.

E) Consent to use of a physical restraint by the resident, family member or designated representative must be obtained and documented as above when life threatening situations (such as dehydration, electrolyte imbalance, urinary blockage) require such use temporarily for brief periods of time to provide necessary life saving treatment.

F) In any event that a physical restraint is used, the resident's plan of care must indicate that such restraint is used only for the times and duration necessary to enable him/her to attain and maintain the highest practicable physical, mental and psychosocial function. Evidence of periodic re- evaluation of the need for physical restraints and efforts to eliminate use of such must be present in the resident's plan of care.

A) When the resident's medical condition appears to require treatment with psychoactive medication, the attending physician will be notified.

B) An appropriate order will be obtained to include specific dosage, specific intervals and the specific condition for which the treatment is required. If the order is taken verbally, a written order is required within 48 hours.

C) At the outset of treatment, begin initial monitoring of the resident's condition by using the Assessment of Pharmacological Behavior Modification Form, and on-going evaluation will be continued as outlined in nursing procedure #9A, "Use of Psychoactive Drugs."

D) Incorporate the need for, the effects of, and the continued use of the psychoactive medication into the resident's interdisciplinary plan of care.

E) Report any adverse drug reactions to the resident's attending physician immediately.

F) After the initial assessment is completed, review the resident's treatment regimen with the attending physician at each regular or alternate schedule of examination, unless indicated more frequently by the resident's condition, or at the request of the resident, next of kin or designated representative.