Failure to Document Bed Alarm Use in Resident Care Plans
Penalty
Summary
The facility failed to develop and implement care plans for two residents who were using bed alarms as fall prevention interventions, as required by facility policy. For one resident with diagnoses including generalized muscle weakness, anxiety disorder, and urinary tract infection, the care plan did not include the use of a bed alarm, despite the resident being observed with one in use and staff confirming its purpose for fall prevention. The resident's care plan only addressed other safety measures such as adequate lighting, bed positioning, and call light accessibility, omitting the bed alarm intervention. Similarly, another resident with depression, hypothyroidism, and generalized muscle weakness was observed with a bed alarm in place, and staff confirmed its use for fall prevention. However, this intervention was not documented in the resident's care plan. Facility staff, including a CNA, LVN, and RN, acknowledged that the care plans should have reflected the use of bed alarms, in accordance with the facility's policy, which requires interdisciplinary team involvement and documentation of such interventions in the care plan for residents at risk for falls.