CMS SOM App. J, Tag W128

are provided active treatment to reduce dependency on drugs and physical restraints;

Guidance §483.420(a)(6)

The facility must implement an aggressive active treatment program, which includes

appropriate replacement behaviors, to address the reduction/elimination of physical restraints

and drugs to manage behaviors.

For purposes of this Guideline drugs to manage behavior are “unnecessary” if there is evidence

the drugs are being used:

• In excessive dose (duplicate therapy);

• For excessive duration;

• Not monitored adequately;

• Without adequate indications for its use;

• With adverse consequences which indicate the dose should be reduced or discontinued;

or

• Any combination of the reasons listed above.

The long term use of a drug/physical restraint to manage behavior combined with one or more

of the following may indicate unnecessary use:

• The client's developmental and/or behavioral needs are not being met and the

appropriateness of less restrictive approaches to manage inappropriate behaviors

should be questioned;

• Staff behavior may be prompting behaviors in clients which result in the chronic use of

physical restraints and drugs to control behavior;

• Staff may have inadequate training and/or experience to provide active treatment and

employ preventive measures;

Restraints applied for behaviors when less restrictive measures have not been tried or have been

tried and found to be just as effective.