Ask Proactive – We are in the process of reviewing the Restorative Nursing Ambulation program. Some residents are only able to walk very short distances. Would these patients be appropriate for the program?

Q:

We are in the process of reviewing the Restorative Nursing Ambulation program.  Some residents are only able to walk very short distances.  Would these patients be appropriate for the program?

 

A:

The restorative ambulation program should include activities provided to improve or maintain the resident’s performance with respect to walking. The RAI manual outlines specific criteria that should be met to qualify as restorative nursing programs, which includes the following:

• Measurable objectives and interventions documented in the care plan and the medical record
• Evidence of periodic evaluation by a licensed nurse
• Nursing assistants/aides must be trained in techniques that promote resident involvement

For each resident in the restorative ambulation program, the objectives of the program and interventions should be individualized by the resident’s strengths and needs, provided in accordance with the care plan, monitored, and evaluated for ongoing appropriateness.

For residents with low activity tolerance unable to ambulate longer distances, restorative nursing programs may be broken into smaller sessions throughout the day.  For example, a walk-to-dine program can be broken down into multiple sessions by walking to and from meals each day. When needed, the walk-to-dine program can be graded down to meet the resident’s ability to participate—for example, Instead of walking all the way from their room to the dining room, the ambulation may start at a point outside of the dining room and include walking to a chair in the dining room with assistance and following the meal, walking back to their wheelchair outside the dining room with assistance.   The documentation for each session should include the distance ambulated and the total number of minutes spent on the walking activity

In the steps for assessment for O0500 Restorative Nursing Programs, the RAI manual states, ‘For the 7-day look-back period, enter the number of days on which the technique, training or skill practice was performed for a total of at least 15 minutes during the 24-hour period.’  Recording the actual minutes for each walking session will provide the documentation for the time spent each day in the walk-to-dine/ ambulation program.

 

Next Steps:

1. Join Proactive April 2 for a full day Restorative Nursing Workshop to gain insight into overcoming barriers to successful Restorative Programs!
2. In May-June, join us for TEAM MDS! sessions on coding mobility status and care planning.
3. Access the on-demand session Enhancing Functional Outcomes to drive programs that target helping residents achieve and maintain their highest practical level of function and prevent functional decline

 

 

 

Written By:

 

Susan Pokorny, RN, GERO-BC, RAC-CT, RAC-CTA

MDS Consultant

Proactive LTC Consulting

 

Was this article helpful? Access weekly insights when you sign up for our weekly newsletter!