Unauthorized Use of Physical Restraint on Cognitively Impaired Resident
Penalty
Summary
A deficiency occurred when a resident with severe cognitive impairment and total dependence for activities of daily living was found in a wheelchair with a white blanket wrapped around his lower abdomen to knees, with the edges secured to the wheelchair, effectively restraining him. The resident had a physician order and consent for a self-release seat belt, but there was no order or consent for the use of a blanket as a restraint. The facility's records indicated the resident lacked capacity to make decisions, and the Minimum Data Set confirmed severe impairment in daily decision-making. Observations revealed that the blanket was tied at the back of the wheelchair, and staff interviews confirmed that the blanket was not a self-release device and should not have been used in that manner. Both the LVN and CNAs interviewed stated that the resident could not have tied the blanket himself, and that staff should have checked to ensure no unnecessary restraints were applied. The Assistant Director of Nursing and Director of Nursing both acknowledged that the use of the blanket as a restraint was not authorized, and that the facility's policy for restraint use, which requires assessment, physician order, and monitoring, was not followed in this case. The facility's policy defined physical restraints as any device or material that the resident cannot remove easily and which restricts freedom of movement. The policy also outlined the need for assessment, physician order specifying the restraint, purpose, and monitoring, as well as informed consent. In this incident, these procedures were not followed, resulting in the unauthorized use of a physical restraint on the resident.