Failure to Honor Resident's Right to Bedtime Choice Results in Injury
Penalty
Summary
A resident with a history of chronic pain, left upper arm contracture, debility, stroke, left-sided paralysis, and dementia was reviewed for her right to self-determination and choice. The care plan noted that the resident may refuse to return to her room for incontinence care or go to bed at a reasonable time, with interventions to assess decision-making ability and provide a consistent routine. Despite this, staff attempted to put the resident to bed between 9:00 PM and 10:00 PM, although she was known to resist going to bed and preferred to stay up. During the process of undressing her and preparing her for bed, the resident became agitated, fought with staff, and began swinging her arm. Staff left the room to seek assistance, and multiple CNAs attempted to help, but the resident continued to resist and became increasingly upset. Subsequently, the resident was transferred to bed using a Hoyer lift by another CNA, during which she was observed to be crying and calling staff names. Later, the resident complained of severe pain in her left shoulder, which was assessed by nursing staff and found to be swollen and tender. She was sent to the emergency department, where imaging revealed a closed fracture of the surgical neck of the left humerus. The resident reported to staff and emergency personnel that her arm had been pulled during care, and she repeatedly stated that her arm was broken by staff. Staff interviews confirmed that the resident was typically resistive to going to bed and that her preferences were not accommodated on the night of the incident. Observations and interviews with staff and the resident indicated that her right to make choices about her bedtime and care routine was not honored. Staff acknowledged that the resident preferred to stay up late and often refused to go to bed, but on the night in question, they proceeded with care despite her resistance. The failure to respect the resident's choices and to re-approach her at a later time contributed to her agitation and the subsequent altercation, which resulted in a significant injury.