Failure to Attempt Less Restrictive Alternatives and Monitor Physical Restraint Use
Penalty
Summary
The facility failed to implement less restrictive alternatives before using a Geri-chair with a lap tray as a physical restraint for a resident with severe cognitive impairment and significant physical care needs. The resident, who had diagnoses including dementia, anxiety, and convulsions, was dependent on staff for most activities of daily living and was unable to make decisions or understand the use of the restraint. The Geri-chair with lap tray was ordered and used to prevent the resident from falling, but there was no evidence that less restrictive interventions were attempted prior to its implementation. Record reviews and staff interviews confirmed that the Geri-chair with lap tray was considered a restraint, and that no monitoring or ongoing assessment was conducted for its continued use. The care plan referenced the use of the Geri-chair with lap tray and included goals to prevent complications, but did not document interventions for reducing or discontinuing the restraint. Staff acknowledged that monitoring was only performed for residents with non-self-release lap bands, not for those with lap trays, and that no care plan interventions were in place to address restraint reduction for this resident. The facility's policy required that restraints only be used after less restrictive alternatives had been tried unsuccessfully, and that ongoing re-evaluation and documentation were necessary. However, both the RN and DON confirmed that less restrictive interventions were not attempted before the lap tray was introduced, and that there was no documentation or monitoring for the continued need for the restraint. This failure to follow policy and regulatory requirements resulted in the deficient practice identified by surveyors.