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Chemical Restraint Examples

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP

March 29, 2018

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Question

Can you define chemical restraints and provide us with some examples?  

Answer

A chemical restraint is defined as any drug that is used for discipline or staff convenience, and not required to treat the medical symptom. If we're going to use a chemical restraint, we need to use the least restrictive alternative for the least amount of time, provide ongoing re-evaluation of the need for the medication, and not use that medication for discipline or convenience.

Chemical restraints are commonly used because of behaviors, particularly dementia-related behaviors. You may be thinking that it is outside of our scope of practice as therapists to look at some of these medications. However, it is most definitely within our scope of practice to provide alternatives for those behaviors. As therapists, we have a huge opportunity to come in and recreate the environment and figure out a cuing strategy and come up with non-pharmacological solutions, versus resorting to a medication. While the meds are not within a PT's scope, all of those other non-pharmacologicals that CMS is looking at are certainly within our scope.

The definitions for convenience, discipline and medical symptom as they relate to chemical restraints are the same as for physical restraints. The indication for use, however, is defined as "the identified, documented clinical rationale for administering a medication that is based upon an assessment of the resident’s condition and therapeutic goals and is consistent with manufacturer’s recommendations and/or clinical practice guidelines, clinical standards of practice, medication references, clinical studies or evidence-based review articles that are published in medical and/or pharmacy journals." Essentially, that's Medicare's way of saying that chemical restraints are not acceptable. We need to find non-pharmacological interventions, instead of relying on these types of medications.

Some examples of chemical restraints include antipsychotics, antidepressants, antianxieties, and sedatives: things that are not used to treat a medical condition. Again, when you're in long-term care, if you look at the minimum data set (MDS) that facilities are completing, they're looking at these examples and the requirements are pretty strict right now that we can no longer do PRN orders for these medications. There needs to be a lot of documentation in place to use them.

Examples of Convenience: Chemical Restraint

Other examples of facility practices that indicate a medication (ordered by a practitioner) is being used as a chemical restraint for staff convenience or discipline include, but are not limited to:

  • Staff indicate that a medication is being administered based on the resident’s representative’s request to administer a medication to “calm down” the resident
  • Staff have recommended to the practitioner that a resident be administered a medication in order to prevent a resident from displaying behaviors such as wandering into other resident’s rooms
  • Staff administer a medication to quiet the resident because the resident continually calls out, without attempting alternative interventions
  • Staff become frustrated with a resident who continually requests staff assistance (such as for toileting), or continually puts on the call light, and administer a medication to sedate or subdue the resident
  • Staff administer a medication that subdues or sedates a resident when insufficient staffing levels do not allow for the resident’s needs to be met
  • Staff administer a medication to sedate or subdue the resident, and/or to restrict the resident to a seated or lying position since the resident continually wanders into other resident’s rooms or attempts to leave the unit
  • Staff becomes upset with a resident who resists receiving a bath and pinches staff. The staff had neither re-assessed the resident nor revised interventions regarding how to provide bathing care in order to meet the resident’s needs. Instead, of using good person-centered care, staff administer a medication that is used to subdue the resident prior to providing the bath, but the medication is not used to treat an identified medical symptom. 

 


kathleen d weissberg

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP

Kathleen Weissberg, OTD, OTR/L, in her 25 years of practice, has worked in adult rehabilitation, primarily in long-term care as a clinician, manager, researcher, and most recently as Education Director with Select Rehabilitation where she oversees continued competency and education for close to 12,000 therapists. In her role, she conducts audits and provides denials management and quality improvement planning training for more than 700 LTC sites nationwide. She also conducts compliance, ethics, and jurisprudence training to therapists.  Kathleen has authored several publications that focus on patient wellness, fall prevention, dementia management, therapy documentation, and coding/billing compliance.  

 


Related Courses

Put Down the Drugs: Evidence-Based Interventions to Reduce Unwanted Behaviors with Dementia
Presented by Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Recorded Webinar

Presenter

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Course: #3072Level: Intermediate1 Hour
  'Informative'   Read Reviews
PTs can apply evidence-based interventions to improve dementia care. This session reviews the etiology of common behaviors. Cognitive-emotion, multi-sensory, animal-assisted, and exercise interventions to reduce agitation are discussed as well as specific strategies for improving task-related engagement. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Dementia Management: Techniques for Staging and Intervention
Presented by Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Recorded Webinar

Presenter

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Course: #3649Level: Intermediate2 Hours
  'Lists good information about dementia as it relates to the PT'   Read Reviews
This seminar provides an overview of types of dementia including characteristics at each stage, protocols for staging clients with dementia and related treatment strategies. Documentation and treatment planning based on dementia staging results is reviewed. Behavior management and communication strategies for this population are discussed as well as techniques for nursing to follow. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Fall Management: Evidence-Based Interventions for Screening and Intervention
Presented by Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Recorded Webinar

Presenter

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Course: #3704Level: Intermediate2 Hours
  'The presenter was clear in her presentation and I felt she was confident in her delivery of the subject matter'   Read Reviews
This session will review evidence-based screening and intervention strategies applicable to a balance and falls management program including research-based exercise programs, environmental modification, patient and caregiver education and balance retraining activities. Falls management program rationale and implementation is also discussed as well as interdisciplinary techniques and strategies to reduce fall risk in the elderly. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Supporting the LGBTQ Senior in Healthcare
Presented by Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Recorded Webinar

Presenter

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Course: #3454Level: Intermediate2 Hours
  'Very relevant and easy to follow along'   Read Reviews
This training describes the required elements for responding to the emerging needs of long term care communities to provide sensitive and respectful services to LGBT elders. The training reviews definitions related to sexual orientation and gender identity challenges experienced by LGBT older adults, and strategies for communication and policies that honor residents' rights. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Restraint Reduction: Regulations, Alternatives and Therapy Intervention
Presented by Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Recorded Webinar

Presenter

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Course: #2955Level: Introductory2 Hours
  'The presenter is obviously very knowledgeable and passionate about the topic'   Read Reviews
This session will review updated regulations related to physical and chemical restraints in long-term care. Resident assessment, therapy interventions, and alternatives to restraints will be discussed. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.