Failure to Follow Care Plan Interventions for Resident Refusing Care
Penalty
Summary
Staff failed to consistently implement care plan interventions for a resident with a history of combativeness and resistance to care. The resident, who had significant cognitive impairment, dementia, and diabetes, was care planned to allow refusal of care, with instructions for staff to maintain safety and reapproach at a later time if care was refused. On one occasion, despite the resident verbally refusing foot care and displaying combative behavior, staff continued with the care instead of following the intervention to reapproach later. The care plan also indicated that staff should not force care and should notify the provider if the resident refused. Interviews with facility staff confirmed that the charge nurse was aware of the resident's refusal and the care plan interventions but proceeded with the care due to the presence of the podiatrist and time constraints. The assistant director of nursing acknowledged that the charge nurse should not have forced the resident to accept treatment and should have sought assistance from leadership for alternative care. The failure to follow the established care plan interventions resulted in the deficiency.