Failure to Follow Restraint Policy for Resident Using Abdominal Binder
Penalty
Summary
A deficiency occurred when the facility failed to follow its own restraint policy for a resident who was using an abdominal binder as a physical restraint. The facility did not attempt alternative interventions prior to the application of the abdominal binder, as indicated in the restraint-physical initial evaluation. Additionally, the required informed consent for the restraint was incomplete, lacking a physician's signature and date. The resident's medical records also did not include a care plan addressing the use of the abdominal binder as a restraint. The resident involved had multiple medical diagnoses, including chronic obstructive pulmonary disease (COPD), dysphagia, type 2 diabetes mellitus, and a gastrostomy. The resident was cognitively impaired and dependent on staff for all activities of daily living. Despite these complex needs, staff did not document monitoring of the resident every 30 minutes while the abdominal binder was in use, as required by facility policy. Observations confirmed that the resident was wearing the abdominal binder, and interviews with nursing staff revealed that monitoring and assessment for comfort, tolerance, and breathing difficulties were not performed or documented. Interviews with facility staff, including an LVN, RN, and the Assistant Director of Nursing, confirmed that the facility's procedures were not followed. Staff acknowledged that alternatives to restraint were not tried, informed consent was not properly obtained, and ongoing monitoring and care planning for the restraint were not completed. The facility's policy required that restraints only be used after unsuccessful alternatives, with ongoing documentation, physician orders, and care plans reflecting the use and need for restraints, none of which were fully implemented in this case.
Plan Of Correction
Corrective action: On 7/11/25, the physician's order for the use of abdominal binder for Resident 2 was discontinued and carried out. An individualized care plan to address the use of the abdominal binder was developed on 07/10/2025 for Resident #2. An in-service to the MDS nurses was done by the Regional MDS nurse on 07/9/2025 to discuss the completion of care plans for residents with abdominal binder orders, individualized to address resident needs, clinical conditions, and medical necessity for use. **Identification of others:** On 7/11/25, the DON/ADON conducted a chart audit and reviewed residents with current orders for abdominal binders/physical restraints to ensure that less restrictive interventions were attempted or tried prior to applying a physical restraint. No other residents were identified with the same deficient practice. The Medical Records designee conducted a health records audit on 7/11/25 to ensure residents with an abdominal binder/physical restraint have a complete informed restraint consent. No other residents were identified with the same deficient practice. On 7/11/25, the DON/ADON and Medical Records designee reviewed MAR/TAR records on residents with current orders for abdominal binders/physical restraints to ensure that residents are monitored every 30 minutes while the abdominal binder is in use. No other residents were identified with the same deficient practice. The Lead MDS nurse completed an audit on residents who currently have an abdominal binder/physical restraint order and reviewed to ensure an individualized care plan for abdominal binder/physical restraint use is addressed/updated. No other residents were identified for this deficient practice. **Process to prevent recurrence:** An in-service to all licensed nurses was conducted by the DON on 7/11/25 to discuss trying alternatives prior to the use of an abdominal binder/physical restraint. An in-service to all licensed nurses was conducted by the DON on 7/10/25 to discuss the completion of informed restraint consent when a resident has an order for an abdominal binder/physical restraint. Also, staff must monitor every 30 minutes. An in-service to all licensed nurses was conducted by the DON on 7/9/25 to discuss the completion of care plans for residents with abdominal binder orders, individualized to address resident needs, clinical conditions, and medical necessity for use. The Medical Records designee will conduct a weekly audit for six weeks and monthly thereafter for three months to ensure there is an informed restraint consent completed for residents with an abdominal binder/physical restraint. She will also check the MARS/TARS to ensure the residents are being monitored every 30 minutes. All findings will be reported to the DON. The DON/ADON will ensure care plans for abdominal binder use are addressed for all residents with current abdominal binder orders/physical restraints. Furthermore, the MDS nurses will review/update restraint care plans quarterly and as needed, per protocol. **Monitoring performance:** The DON/ADON will review residents with current orders for abdominal binder application several times a week for six weeks and weekly thereafter for 3 months to ensure that less restrictive interventions were attempted and/or other alternative options prior to abdominal binder/physical restraint. The Director of Nursing will discuss findings at the Quality Assurance and Improvement Committee monthly for evaluation and further action. The DON/ADON and Medical Records designee will check resident records MAR/TAR weekly for six weeks and monthly thereafter for 3 months to ensure residents are being monitored every 30 minutes. An in-service to all licensed nurses was conducted by the DON on 7/9/25 to discuss the completion of care plans for residents with abdominal binder orders, individualized to address resident needs, clinical conditions, and medical necessity for use. The Medical Records designee will conduct a weekly audit for six weeks and monthly thereafter for three months to ensure there is an informed restraint consent completed for residents with an abdominal binder/physical restraint. She will also check the MARS/TARS to ensure the residents are being monitored every 30 minutes. All findings will be reported to the DON. The DON/ADON will ensure care plans for abdominal binder use are addressed for all residents with current abdominal binder orders/physical restraints. Furthermore, the MDS nurses will review/update restraint care plans quarterly and as needed, per protocol. **Monitoring performance:** The DON/ADON will review residents with current orders for abdominal binder application several times a week for six weeks and weekly thereafter for 3 months to ensure that less restrictive interventions were attempted and/or other alternative options prior to abdominal binder/physical restraint. The Director of Nursing will discuss findings at the Quality Assurance and Improvement Committee monthly for evaluation and further action. The DON/ADON and Medical Records designee will check resident records MAR/TAR weekly for six weeks and monthly thereafter for 3 months to ensure residents are being monitored every 30 minutes. The Director of Nursing will discuss findings at the Quality Assurance and Improvement Committee monthly for evaluation and further action. The Regional MDS nurse shall conduct chart audits monthly for 3 months with a focus on care plans for residents with current restraint orders and will provide a report of findings to the Administrator/QA committee for review and further recommendations.