Resident Restrained Without Physician Order
Penalty
Summary
A deficiency was identified when a resident with severe cognitive impairment, as indicated by a BIMS score of 0 and diagnoses including vascular dementia, peripheral vascular disease, and anxiety disorder, was found physically restrained in bed without a physician's order. The resident was discovered by therapy staff with the bed pushed against the wall, an over-bed table placed over them, and multiple pieces of furniture, including two chairs, a wheelchair, and a nightstand, barricading them in the bed. Review of facility policies confirmed that residents are to be free from physical restraints unless required to treat a medical symptom and ordered by a physician, with ongoing evaluation of need. Staff interviews revealed that the restraint was implemented in an attempt to keep the resident safe after multiple incidents of the resident placing themselves on the floor and exhibiting combative and verbally aggressive behavior. There was no evidence of harm or distress to the resident at the time, and no restraint order was found in the clinical record. The facility's Director of Nursing and Nursing Home Administrator confirmed that the use of physical restraints occurred without a physician's order, in violation of facility policy and state regulations.