Failure to Ensure Resident Freedom from Unnecessary Physical Restraints
Penalty
Summary
The facility failed to ensure that a resident was free from the use of physical restraints imposed for convenience and not required to treat medical symptoms, as observed over a four-day survey period. The resident, an elderly female with diagnoses including dementia, hypertension, and diabetes, was consistently seated in a Geri-chair with a tray table attached whenever she was out of bed. The tray table was not removed during meals or activities, and there was no documentation of ongoing re-evaluation of the need for the restraint. Staff interviews confirmed that the tray table was always used when the resident was out of bed, and alternative interventions were not documented or attempted prior to or after the use of the Geri-chair with tray table. Record reviews revealed inconsistencies and lack of clarity regarding the use of the restraint. The resident's care plan noted the use of the Geri-chair with or without a tabletop to prevent falls and serve as a table for activities, but did not include interventions for removing the tabletop or assessing the continued need for the restraint. Physician orders and informed consent forms referenced the use of the Geri-chair with or without the tabletop as a safety device, but documentation of less restrictive alternatives and ongoing assessment was incomplete or missing. Physical restraint elimination assessments indicated the resident was a good candidate for restraint elimination, yet the action plan consistently stated no restraint elimination at this time, with minimal documentation of less restrictive measures or specific medical symptoms justifying the restraint. Observations during the survey showed the resident was able to move her upper body and interact with her environment, but was always restrained by the tray table when in the Geri-chair, except for one instance when she was in a wheelchair without a restraint and did not attempt to get up. Staff interviews indicated the restraint was used for fall prevention and at the request of the resident's family, but there was no evidence of regular re-evaluation or consideration of less restrictive alternatives. The facility's restraint policy referenced compliance with laws and professional judgment, but the practice observed did not align with requirements for restraint use only when necessary for medical treatment and with ongoing assessment.