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The minimum data set prevalence of restraint quality indicator: does it reflect differences in care?
John F Schnelle1, Barbara M Bates-Jensen, Lené Levy-Storms
1Borun Center for Gerontological Research, Department of Medicine, University of California-Los Angeles, 7150 Tampa Avenue, Reseda, CA 91335, USA. jschnell@ucla.edu
The Gerontologist
|April 13, 2004
Summary
Nursing homes with high restraint use indicators did not differ in out-of-bed restraint use. However, these homes showed more in-bed restraint use, longer resident bed times, and less feeding assistance, indicating quality of care differences.
Area of Science:
- Gerontology
- Nursing Home Quality
- Patient Safety
Background:
- The Minimum Data Set (MDS) restraint prevalence quality indicator is used to assess restraint device use in nursing homes.
- Understanding the relationship between this indicator and actual care quality is crucial for improving resident well-being.
Purpose of the Study:
- To investigate differences in restraining device use and care quality between nursing homes scoring in the upper and lower quartiles on the MDS restraint prevalence quality indicator.
- To determine if the MDS indicator accurately reflects variations in care processes and resident outcomes.
Main Methods:
- A cross-sectional study involving 413 residents across 14 nursing facilities, categorized into low (n=8) and high (n=6) prevalence restraint homes based on MDS scores.
- Direct observations over three 12-hour days assessed restraint use, resident behaviors, and care processes, including feeding assistance and physical activity.
Main Results:
- Residents in high-restraint homes spent more time in bed during the day (44% vs. 33%) and had higher rates of bed rail use (74% vs. 64%) compared to low-restraint homes.
- No significant differences were found in the use of out-of-bed restraints or in care process measures related to restraint management, gait/balance, or physical/social activity.
- Residents in high-restraint homes received less feeding assistance during meals (2.7 min vs. 4.1 min).
Conclusions:
- The MDS restraint prevalence indicator did not correlate with differences in out-of-bed restraint use or overall physical/social activity.
- Significant differences in in-bed restraint use, daytime bed occupancy, and feeding assistance suggest the indicator may not fully capture quality of care variations.
- The findings highlight the need for improved monitoring methods focusing on resident freedom of movement, in-bed time, and exercise to better assess and enhance nursing home care quality.