Understanding and Coding MDS 3.0 Item P0100G: "Restraints in Chair/Out of Bed: Chair Stops Rising"

Introduction

Purpose:
In long-term care settings, the use of restraints, including those that prevent a chair from rising, requires careful documentation and ethical consideration. MDS Item P0100G, "Restraints in Chair/Out of Bed: Chair Stops Rising," is used to document the use of this specific type of restraint, which is designed to prevent residents from standing up unassisted, thereby reducing the risk of falls. Proper documentation ensures compliance with regulatory standards and supports resident safety while minimizing the use of restraints. This article provides detailed guidance on how to correctly code this item according to CMS standards.

What is MDS Item P0100G?

Explanation:
MDS Item P0100G, "Restraints in Chair/Out of Bed: Chair Stops Rising," is part of Section P, which focuses on the use of devices and restraints in resident care. This item specifically captures the use of a mechanical restraint where a chair is adjusted to stop rising, effectively preventing the resident from standing up. Such a restraint might be used for residents who are at high risk of falls and require close supervision. However, the use of this restraint must be carefully justified, documented, and monitored to ensure it aligns with the resident’s care plan and regulatory requirements.

Accurately documenting the use of a chair that stops rising is crucial for ensuring that all safety measures are recorded, allowing the care team to evaluate the necessity and appropriateness of this intervention.

Guidelines for Coding P0100G

Coding Instructions:
To correctly code Item P0100G, follow these steps:

1. Identify the Use of a Chair That Stops Rising: Determine if the resident is using a chair that has been adjusted to prevent it from rising. This includes chairs that are mechanically or electrically modified to lock in place and prevent the resident from standing up without assistance.
2. Evaluate the Purpose and Justification: Ensure that the use of this restraint is for safety purposes, particularly to prevent falls, and that it is necessary as part of the resident’s care plan. Consider whether less restrictive alternatives have been explored and documented.
3. Select the Appropriate Response:
   • 0: No - Select this code if the resident is not using a chair that stops rising.
   • 1: Yes - Select this code if the resident is using a chair that stops rising.
4. Enter the Response in Item P0100G: Record the selected response in Item P0100G. Ensure that the resident’s care plan includes detailed documentation of the restraint’s purpose, how it is used, and the rationale for its continued use.
5. Document the Details of the Restraint: If a chair that stops rising is used, provide additional documentation describing the type of chair, how and when it is used, and the conditions under which it is applied. Also, document regular assessments to evaluate the resident’s need for the restraint and efforts to minimize its use.

Example Scenario:
A resident with severe balance issues is prone to falling when attempting to stand up from their chair. To prevent falls, the care team uses a specialized chair that stops rising, requiring staff assistance before the resident can stand. The MDS Coordinator documents the use of this restraint in Item P0100G by selecting code 1 ("Yes"). This documentation ensures that the care plan reflects the use of the restraint and allows for ongoing monitoring and assessment.

Best Practices for Accurate Coding

Documentation:
Maintain thorough documentation of the specific chair restraint used, including its purpose and how it contributes to the resident’s safety. Ensure that the use of this restraint is justified, and less restrictive alternatives have been considered. This documentation should support the coding of Item P0100G and provide a clear record for compliance and monitoring.

Communication:
Ensure effective communication among the care team about the use of restraints. All staff members should be informed of the rationale for using a chair that stops rising, how to monitor its use, and the plan for reassessment to reduce or eliminate the need for the restraint.

Training:
Provide regular training to staff on the appropriate use of restraints, focusing on reducing their use and employing alternative interventions whenever possible. Staff should understand the ethical considerations surrounding restraint use and be proficient in documenting it correctly.

Conclusion

Summary:
MDS Item P0100G is essential for documenting the use of chairs that stop rising as a form of restraint in long-term care settings. By accurately coding this item and ensuring clear documentation, healthcare professionals can monitor restraint use to ensure it is appropriate, minimal, and in line with CMS regulations. Following the guidelines and best practices outlined in this article will help ensure that all safety measures, including the use of this type of restraint, are properly managed and documented.

Reference

CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024. Refer to [Chapter 3, Page 3-50] for detailed guidelines on the use of devices and restraints in resident care and the importance of documenting the use of restraints that prevent a chair from rising.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item P0100G: "Restraints in Chair/Out of Bed: Chair Stops Rising" was originally based on the CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024. Every effort will be made to update it to the most current version. The MDS 3.0 Manual is typically updated every October. If there are no changes to the Item Set, there will be no changes to this guide. This guidance is intended to assist healthcare professionals, particularly new nurses or MDS coordinators, in understanding and applying the correct coding procedures for this specific item within MDS 3.0. The guide is not a substitute for professional judgment or the facility’s policies. It is crucial to stay updated with any changes or updates in the MDS 3.0 manual or relevant CMS regulations. The guide does not cover all potential scenarios and should not be used as a sole resource for MDS 3.0 coding. Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice. Users are responsible for ensuring compliance with all applicable laws and regulations in their respective practices.