Failure to Honor Resident's Right to Refuse Medication and Avoid Restraint
Penalty
Summary
A resident with diagnoses including malignant neoplasm of the breast, hypertension, dementia, depression, and anxiety, and who was assessed as having severe cognitive impairment, was administered morphine despite expressing refusal. The resident's care plan identified her as high risk for exploitation and directed staff to allow her to make decisions about her treatment as able, including respecting refusals of medication. On the day of the incident, the resident was observed calling out and refusing medication, verbally expressing 'no' and physically turning her head away. Despite this, a registered nurse instructed a nursing assistant to hold the resident's hands down while morphine was administered orally against her will. Multiple staff members reported the incident, noting the resident's distress and the nurse's actions, including laughing at the resident's complaints. The facility's policy prohibits the use of restraints and emphasizes the use of the least restrictive interventions. Documentation and interviews confirmed that the resident's right to refuse medication was not honored, and physical restraint was used to administer medication, contrary to both the resident's care plan and facility policy.