Failure to Ensure Nursing Staff Competency in Therapeutic Holds for Medication Administration
Penalty
Summary
The facility failed to ensure that licensed nurses and nursing staff possessed the specific competencies and skill sets necessary to care for residents as identified through assessments and care plans, particularly in the use of therapeutic holds for medication administration. A resident with severe cognitive impairment, schizophrenia, anxiety disorder, and psychosis was admitted and consistently refused care and medication. The care plan included interventions for refusal, such as trying alternate staff or approaches, notifying family and physician, and providing alternate settings, but did not address the use of therapeutic holds. On multiple occasions, nursing staff administered intramuscular antipsychotic medications to the resident using a therapeutic hold, involving four staff members to restrain the resident for injection. The DON, ADON, and LVN involved confirmed that no staff had received training or practiced therapeutic holds or restraint techniques for medication administration. The decision to use a therapeutic hold was made after consulting with the psychiatric nurse practitioner and physician, and verbal permission was obtained from the resident's representative, but there was no evidence of staff competency or training in this area. Record review and staff interviews revealed that there were no training records or documentation to show that nursing staff were educated or competent in performing therapeutic holds safely. Staff described discussing their approach among themselves prior to entering the resident's room but acknowledged a lack of formal training or practice in restraint techniques. This lack of training and competency could place residents at risk due to staff not having the appropriate skills to provide care as required by resident needs and care plans.