Failure to Obtain Physician Order and Consent for Use of Chest Restraint
Penalty
Summary
A deficiency was identified when a resident with spastic quadriplegic cerebral palsy and a history of falls was observed using a chest harness in his wheelchair. The resident required substantial to maximal assistance with positioning, mobility, and transfers, and was cognitively moderately impaired. Despite the use of the chest harness, there was no physician order, consent, or documented evaluation of need for the device in the resident's medical record. The quarterly MDS assessment did not indicate the use of a trunk restraint, and the comprehensive care plan lacked any mention of a restraint or the chest harness. Staff interviews revealed that the chest harness was used daily to prevent the resident from falling, and the resident was unable to remove the harness independently. Both the LVN and the DON acknowledged that the resident could not unbuckle the harness himself. The DON and ADM stated that the harness was considered a positioning device rather than a restraint, and therefore did not require the same documentation or physician oversight. However, the facility's own policy defined a restraint as any device that the resident could not remove easily and that restricted freedom of movement, which applied to the chest harness in this case. Further review of facility documentation showed that the use of the chest harness was noted as a stability device to prevent the resident from slipping out of his chair. Despite this, there was no evidence of a risk assessment, consent, or physician order for its use, as required by facility policy. The policy also specified that restraints should only be used upon written physician order, with documented consent and ongoing evaluation, none of which were present for this resident.