411-086-0140 Nursing Services: Problem Resolution and Preventive Care (1) Problem Resolution and Prevention: (a) Conditions to be Prevented. The licensee shall take all reasonable measures consistent with resident choice to resolve and to prevent undesirable conditions such as: (A) Decubitus ulcers and other skin breakdowns; (B) Loss of mobility, or development of contractures or foot drop; (C) Dehydration; (D) Impaction; (E) Infections; (F) Weight loss/gain; (G) Loss of range of motion; (H) Loss of bowel and bladder control; and (I) Loss of self-esteem or dignity. (b) Reasonable Measures. Reasonable measures which are required to be taken include, but are not limited to: (A) Assessment of residents who are at risk; (B) Implementation of preventive measures; and (C) Reassessment and modification of treatment program when the program implemented is not effective. (2) Safe Environment. The licensee shall ensure the provision of a safe environment to protect residents from injury. Actions taken by the facility staff shall be consistent with each resident’s right to fully participate in his or her own care planning and shall not limit any resident’s ability to care for herself/himself: (a) Dangerous Conditions. The licensee shall take all reasonable precautions to protect a resident from possible injury from dangerous conditions; (b) Falling, Wandering, Negligence. The licensee shall take all reasonable precautions to protect a resident from possible injury from falling, wandering, other resident(s), staff and staff negligence; (c) Reasonable Precautions. Reasonable precautions include, but are not limited to, provision and documentation of an assessment and evaluation of resident’s condition, medications, and treatments, and completion of a care plan, consistent with OAR 411-086-0060; and, when appropriate: (A) Physician notification; (B) Provision of additional inservice training; and/or (C) Evaluation/adjustment of staffing patterns and supervision. (d) The licensee shall take all reasonable precautions to protect a resident from dangerous conditions relating to remodeling or construction. (3) Restraints. The licensee shall ensure that, except when required in an emergency, physical and chemical restraints are only applied in accordance with the resident’s care plan. Restraints may be used only to ensure the physical safety of the resident or other residents: (a) Freedom of Choice. When restraints are considered in the interdisciplinary care planning conference to reduce the risk of injury related to falls, the resident or his/her legal guardian or person acting under the resident’s power of attorney for health care must be informed of the potential risks of falling and the risks associated with restraints; (b) Physician Orders Required. Except as provided in subsection (3)(c) of this rule, physical and chemical restraints may be applied only when a physician orders restraints. An order for restraints must clearly identify the reason for the restraints and the duration and circumstances under which they are to be applied; (c) Emergencies. In an emergency situation, a registered nurse may use physical restraints without physician orders if necessary to prevent injury to the resident or to other residents and when alternative measures do not work. If restraints are used in an emergency situation, the registered nurse shall document in the resident’s clinical record the use of restraints and what alternative measures did not work. A licensed nurse shall contact the physician for restraint orders within 12 hours of application; (d) Re-evaluation. Whenever restraints are used, circumstances requiring the restraints and the need must be continually re-evaluated and documented in the clinical record; (e) Staff Convenience/Discipline. Restraints shall not be used for discipline or staff convenience; (f) Periodic Release. Residents who are physically restrained must have the restraints released at least every two hours for a minimum of ten minutes and be repositioned, exercised or provided range of motion during this period; (g) Toileting. Toileting and incontinence care shall be provided when necessary; (h) Quick Release. All physical restraints must allow for quick release. Locked restraints may not be used; (i) Fixed Objects. Residents shall not be physically restrained to a fixed object. (4) Documentation. All preventive measures taken by the facility staff shall be clearly documented. Such documentation shall include assessment of resident(s) at risk, preventive measures taken, results and evaluation of measures taken, and revision of measures as appropriate. Statutory/Other Authority: ORS 410.070, 410.090 & 441.055 Statutes/Other Implemented: ORS 441.055 & 441.615 History: SSD 8-1993, f. & cert. ef. 10-1-93 SSD 19-1990, f. 8-29-90, cert. ef. 10-1-90