Percentage of long-term care home residents in daily physical restraints over the last 7 days

Percentage of long-term care home residents who were physically restrained on a daily basis

Percentage

The indicator is calculated using 4 rolling quarters of data by summing the number of residents that meet the inclusion criteria for the target quarter and each of the previous 3 fiscal quarters. This is done for both the numerator and denominator. The unadjusted value is the quotient of the summed numerator divided by the summed denominator, multiplied by 100 to get the percentage.

Number of LTC home residents in a fiscal quarter who were recorded as having been physically restrained daily during the 7 days preceding their target Resident Assessment Instrument - Minimum Data Set 2.0 (RAI-MDS) assessment

Inclusions:

(P4c = 2) OR (P4d = 2) OR (P4e = 2)

Where,

P4c = Trunk restraint [0,1,2]

P4d = Limb restraint [0,1,2]

P4e = Chair prevents rising [0,1,2]

0 = not used

1 = used less than daily

2 = used daily

Number of LTC home residents in a fiscal quarter with valid RAI-MDS assessments

Inclusions:

To be considered valid, the resident assessment must: 

• Be the latest assessment in the quarter 
• Be carried out more than 92 days after the admission date
• Not be an admission full assessment

Exclusions:

1. Residents who were comatose (B1 = 1)
2. Residents who were quadriplegic (I1bb = 1)

This indicator can be risk adjusted through direct standardization using the Activities of Daily Living (ADL) Long Form, which includes bed mobility, transfer, locomotion, dressing, eating, toileting and personal hygiene self-performance.

Continuing Care Reporting System (CCRS)

Canadian Institute for Health Information (CIHI)

Institution, Province, Region, Rurality, Time

Does not measure the use of bed rails or chemical restraints (i.e. medication). Includes only residents in long-stay beds. The indicator uses 4 rolling quarters of data to have a sufficient number of assessments for risk-adjustment and to stabilize the indicator results from quarter-to-quarter variations, especially for smaller facilities, but this methodology makes it more difficult to detect quarterly changes. Risk-adjusted values are censored if the denominator is less than 30. There may be some inconsistencies in how homes code restraints due to the difference in RAI-MDS physical restraint definition and the Ministry legislated definition. There are also general limitations when using RAI-MDS data, including random error, coding errors, and missing values. Results for fiscal year 2020/21 should be interpreted with caution as the COVID-19 pandemic may have affected data collection. In Ontario, some LTC facilities were unable to complete and/or submit assessments. As a result, CIHI received fewer assessments during the pandemic than in previous years. Additionally, some facilities experienced a decline in admissions. The impact of COVID-19 on the data received by CIHI varies by jurisdiction. Readers are encouraged to interpret results, including comparisons and trends over time, with caution.

A physical restraint is any manual method, or any physical mechanical device, material or equipment that is attached or adjacent to the resident's body, that the resident cannot remove easily, and that restricts the resident's freedom of movement or normal access to his or her body. It is the effect the device has on the resident that classifies it into the category of restraint, not the name or label given to the device, nor the purpose or intent of the device. This definition is different from that of the definition for physical restraint used by the Ministry of Health and Long-Term Care, where intent plays an important role. The restraint use items capture restraint use in the 7 days prior to the target assessment. The unadjusted indicator result is an additional indicator in Quality Improvement Plans (QIPs) and is included in LTC Practice Reports. The reporting period for current performance in QIPs is Q2 (July - September), which represents the data in Q2 as well as the previous 3 quarters. This was a Quality Improvement Plan (QIP) additional indicator for 2018/19, however retired from 2019/20. Data are based on information from mandatory Resident Assessment Instrument - Minimum Dataset 2.0 (RAI-MDS) assessments. The RAI-MDS is a standardized assessment completed for each resident upon admission to LTC and quarterly thereafter by the resident's care team by reviewing the resident’s medical records and speaking to the resident and their family. Health Quality Ontario used an evidence-informed process and expert panel, composed of Ontario-based long-term care home operators, clinicians and researchers, to produce Ontario benchmarks that represent good resident outcomes and high-quality care. The benchmark for this indicator was set at 3% by an expert panel through a modified Delphi process (2012 & 2015). Alongside public reporting performance indicators, benchmarks are an important tool for supporting long-term care homes and sector stakeholders in tracking progress, setting priorities or targets, and learning from homes that are excelling.

25/02/2022 08:57:00