Q&A: Restraint status and mortality reviews

Q: It has been my understanding that coding of restraint status is essential for mortality reviews, but I’ve never heard it explained how this code impacts the chart. Could you explain the impact?

A: This is a great question. Restraint status on its own does not risk adjust for mortality reviews. The underlying disease process for the patient who requires restraints, however, does have the potential to risk adjust for mortality.

Alcohol and/or drug abuse are diagnoses that will risk adjust cases. These patients can go through withdrawal while admitted as inpatients and may require both physical restraints as well as medications to help support them through their withdrawal symptoms.

Patients with dementia, encephalopathy, or psychiatric disorders can also fall into risk adjustment categories as well. Capturing these diagnoses to the highest degree of specificity is important for accuracy and inclusion in these risk adjustment categories. For example, metabolic encephalopathy, encephalopathy unspecified, and “other” encephalopathy will risk adjust in the Elixhauser risk model, but toxic encephalopathy will not.

There are strict guidelines from both CMS and the Joint Commission on when restraints can be used, what methods were used before restraints were applied and how often restraints are assessed when applied. There needs to be daily orders from the physician who has reassessed the need for physical restraints as well. The restraint status code does help define the resources needed to care for the patient, but on its own, it does not risk adjust in mortality metrics.

Editor’s note: Kim Conner, BSN, CCDS, CCDS-O, CDI education specialist for ACDIS/HCPro based in Middleton, Massachusetts, answered this question. Contact her at kconner@hcpro.com.