Failure to Obtain Physician Orders and Consent for Use of Wanderguard and Secured Unit Placement
Penalty
Summary
The facility failed to ensure that a resident was free from the use of physical restraints except as required for medical treatment, as evidenced by the use of a wanderguard and placement in a secured memory care unit without proper physician orders and without obtaining consent from the resident’s representative. The resident, who had diagnoses including Parkinson’s disease, unspecified dementia, Alzheimer’s disease, and anxiety disorder, was cognitively impaired but valued independence and outdoor activities. After an elopement incident, the facility placed a wanderguard on the resident and moved him to the secured unit during the day, but did not have a continuous physician’s order for the device, and the order that was present was only for a single day. The resident continued to wear the wanderguard for an extended period without appropriate orders, and documentation of the device’s use was inconsistent with the resident’s actual status. The facility also failed to obtain consent from the resident’s representative or power of attorney before moving the resident to the secured memory care unit, which restricted his ability to participate in activities that were important to him, such as walking and going outside. Both the resident’s representative and POA expressed concerns that the move was made without their agreement and that the resident was not assessed for the appropriateness of the secured unit. The representative noted that the resident was not provided with personalized activities and that his opportunities for walks and outdoor activities were limited, despite these being identified as very important to him in his care plan and activity assessments. Documentation and staff interviews revealed that the resident’s participation in preferred activities was sporadic and not consistently offered or recorded. Nursing and activity records showed limited engagement in walks and other activities, and there were instances where the resident requested walks but was not accommodated. Staff interviews confirmed that the wanderguard was used as an intervention prior to placement in the secured unit, but the required physician orders and consent processes were not properly followed, leading to the deficiency.