P0100B. Restraints used in bed: trunk restraints

Step-by-Step Coding Guide for P0100B Restraints used in bed: trunk restraints 

1. Review of Medical Records

• Start with a thorough review of the resident's medical records, focusing on nursing notes, physician orders, and physical therapy reports to identify any mention of trunk restraint use.
• Pay special attention to the 7-day look-back period to ensure all instances of trunk restraint usage are captured.

2. Understanding Definitions

• Trunk Restraint: Any manual method, physical, or mechanical device, material, or equipment used to restrict a resident's trunk movement. This includes but is not limited to vests, belts, or soft ties.

3. Coding Instructions

• Code 0: Not used if no trunk restraint was applied at any time during the 7-day look-back period.
• Code 1: Used less than daily if the trunk restraint was used at any time but not every day during the 7-day look-back period.
• Code 2: Used daily if the trunk restraint was used every day during the 7-day look-back period.

4. Coding Tips

• Distinguish between devices used for support, such as posture-correcting devices, and those considered restraints.
• Consult with the interdisciplinary team to understand the purpose behind each device's use, ensuring accurate coding.

5. Documentation

• Document the clinical rationale for trunk restraint use, including specific safety or medical reasons warranting its application.
• Record discussions with residents or families regarding the use of trunk restraints, noting any consent or objections.
• Include ongoing evaluations of the restraint's necessity in the resident's care plan, documenting any attempts at alternative strategies.

6. Common Errors to Avoid

• Misclassifying devices intended for support or medical treatment as restraints.
• Overlooking the documentation of consent for restraint use or failing to explore less restrictive alternatives.
• Not updating the MDS to reflect changes in trunk restraint use within the look-back period.

7. Practical Application

• Example 1: A resident with severe agitation is fitted with a soft vest restraint during daytime hours for safety. Coding: P0100B = 2 (used daily).
• Example 2: A trunk restraint is used occasionally for a resident with severe trunk instability during physical therapy sessions. Coding: P0100B = 1 (used less than daily).
• Example 3: A posture-correcting device is used, which the resident can remove easily; it's intended for support, not restriction. Coding: Not considered a restraint; hence, P0100B would be coded as 0 (not used).

The Step-by-Step Coding Guide for item P0100B 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.