P0100D. Restraint used in bed: other, Step-by-Step

Step-by-Step Coding Guide for P0100D. Restraint used in bed: other

1. Review of Medical Records

• Objective: Carefully review the resident's medical records, focusing on physician orders, nursing notes, and therapy reports to identify any use of non-standard restraints in bed during the 7-day look-back period.
• Key Records to Review: Look for documentation of devices or methods used to restrict the resident's movement in bed that do not fall under the usual categories of limb or trunk restraints.

2. Understanding Definitions

• Other Restraints in Bed: This category includes any unconventional manual methods, physical or mechanical devices, materials, or equipment attached or adjacent to the resident’s body in bed that the resident cannot remove easily, which restricts their freedom of movement. Examples could include specialized sleep garments designed to prevent getting out of bed, or uniquely adapted bed enclosures.

3. Coding Instructions

• Code 0 (Not Used): If no "other" type of restraint was used at any time during the 7-day look-back period.
• Code 1 (Used Less Than Daily): If "other" restraints were used at any time but not on a daily basis during the look-back period.
• Code 2 (Used Daily): If "other" restraints were used every day during the look-back period.

4. Coding Tips

• Verify the purpose behind using each "other" restraint with the care team to ensure it meets the criteria for coding.
• Distinguish between devices intended for therapeutic support and those that are used primarily to restrict movement.

5. Documentation

• Clinical Justification: Clearly document the specific type and purpose of the "other" restraint used, including a detailed description and the clinical rationale for its use.
• Resident and Family Engagement: Record discussions with the resident or their family about the use of "other" restraints, highlighting consent obtained or concerns raised.

6. Common Errors to Avoid

• Not recognizing or coding "other" restraints because they do not fit into traditional restraint categories.
• Inadequate documentation of the clinical justification for using "other" restraints.
• Failing to document or consider the resident's or family's input regarding the use of "other" restraints.

7. Practical Application

• Example: A resident with cognitive impairment and a history of falls has been provided with a bed equipped with a soft enclosure. This enclosure is designed to gently prevent the resident from leaving the bed unassisted during the night, addressing safety concerns while minimizing restriction.
  • Documentation Needed: Note the use of the bed enclosure, including specific details about its function and any relevant physician orders or family discussions.
  • Coding Decision: If the soft enclosure was used every night, code P0100D as 2 (Used Daily). If it was used less frequently, code as 1 (Used Less Than Daily).

The Step-by-Step Coding Guide for item P0100D in MDS 3.0 Section P is based on the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.18.11, dated October 2023. Healthcare guidelines, policies, and regulations can undergo frequent updates. Therefore, healthcare professionals must ensure they are referencing the most current version of the MDS 3.0 manual. This guide aims to assist with understanding and applying the coding procedures as outlined in the referenced manual version. However, in cases where there are updates or changes to the manual after the mentioned date, users should refer to the latest version of the manual for the most accurate and up-to-date information. The guide should not substitute for professional judgment and the consultation of the latest regulatory guidelines in the healthcare field.