Failure to Implement Care Plan for Resident Using Hand Mitten Restraint
Penalty
Summary
The facility failed to implement a care plan for a resident who was using a hand mitten, which is considered a restraint. The resident, admitted with diagnoses including cerebral infarction, legal blindness, and requiring assistance with personal care, was observed with a hand mitten on the right hand. Staff interviews and record reviews revealed that there was no care plan in place for the use of the hand mitten, despite the resident's cognitive impairment and the presence of a physician's order and consent for the mitten after admission. The Minimum Data Set (MDS) did not trigger a care plan for the mitten because the need was identified after the initial assessment, and the nurse who obtained consent did not initiate the care plan as required. Further interviews with nursing staff and the Director of Nursing confirmed that no interdisciplinary team meeting was held and no care plan was developed for the hand mitten. Facility policy requires that care plans for restraints address both immediate medical symptoms and underlying causes, but this was not followed. The lack of a care plan resulted in the absence of documented monitoring for skin integrity, circulation, and other risks associated with restraint use, as required by facility policy.