Resident Restrained with Sheet in Wheelchair by CNA
Penalty
Summary
A deficiency occurred when a certified nurse aide (CNA) used a sheet to physically restrain a resident with severe cognitive impairment in a wheelchair. The resident, who had diagnoses including dementia and generalized anxiety disorder, was dependent on staff for care and mobility and required assistance with ambulation to prevent falls. On the night in question, the CNA reported that the resident was repeatedly attempting to stand and walk unassisted, and, fearing the resident would fall, the CNA wrapped a sheet around the resident's waist and tied it to the wheelchair. The restraint was discovered during morning rounds by another CNA, who observed the resident with the sheet tied around the waist and wheelchair armrests. The resident was not in distress and had no visible injuries at the time. The assistant director of nursing (ADON) was immediately notified, observed the restraint, and directed its removal. The incident was reported to the director of nursing (DON), who confirmed that the use of the sheet constituted a physical restraint. The facility's policy defines physical restraints as any device or material that restricts freedom of movement and cannot be easily removed by the resident, and states that restraints are not to be used for staff convenience or fall prevention. The CNA involved acknowledged making a poor decision, citing the need to care for other residents and concerns for the resident's safety as reasons for the restraint. The use of the restraint was not authorized for medical treatment and was not in accordance with facility policy.