P0100G. Restraint used in chair/ out of bed: chair stops rising

Step-by-Step Coding Guide for P0100G. Restraint used in chair/ out of bed: chair stops rising

1. Review of Medical Records

Start by thoroughly reviewing the resident's medical records, including physician orders, nurses' notes, and documentation by nursing assistants, to identify any instances of restraint usage. Pay special attention to any documented use of devices or methods that may restrict the resident's ability to rise from a chair.

2. Understanding Definitions

Physical Restraint: Any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident’s body that the individual cannot remove easily and restricts freedom of movement or normal access to one’s body.

3. Coding Instructions

P0100G - Chair Prevents Rising: Assess the use of devices or methods that prevent the resident from rising from a chair. This includes geriatric chairs with attached trays, chairs that are too low, or any other device that inhibits standing or exiting the chair.

• Code 0 (Not Used): If the resident did not have any devices that prevented rising from a chair during the 7-day look-back period.
• Code 1 (Used Less Than Daily): If the restraint was used, but not every day.
• Code 2 (Used Daily): If the restraint was used every day during the look-back period.

4. Coding Tips

• Consider all types of chairs used by the resident, including wheelchairs and stationary chairs.
• Assess the resident’s ability to rise from the chair with and without the device in place.
• Be mindful of temporary uses, such as during certain activities or specific times of the day.

5. Documentation

Document the type of chair or device used, the reason for its use, frequency, and any relevant observations about the resident's reaction or any safety incidents related to the device. Ensure that there is a physician’s order supporting the use of the restraint for a medical symptom, and that it is included in the care plan.

6. Common Errors to Avoid

• Failing to recognize devices that indirectly prevent rising (e.g., overly soft or low chairs).
• Not documenting the rationale or physician’s orders for the restraint.
• Overlooking the resident’s ability to consent or their preference regarding the restraint.

7. Practical Application

Example: A resident uses a geriatric chair with a tray fixed across it during mealtimes to prevent slumping. The tray is not removable by the resident, effectively preventing them from rising. This is documented in the care plan to manage the risk of falls due to poor trunk control. The device is used daily during meals.

• Documentation: Include the type of chair, the purpose of the restraint, daily usage during mealtimes, and the resident’s condition that necessitates its use.
• Coding: P0100G would be coded as 2 (Used Daily).

The Step-by-Step Coding Guide for item P0100G 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.