Failure to Ensure Resident's Right to Refuse Restraints and Medication
Penalty
Summary
A deficiency occurred when staff failed to ensure a resident's right to remain free from physical restraints, as required by facility policy and federal regulations. The incident involved a resident with severe cognitive impairment, a history of dementia, depression, anxiety, and malignant neoplasm of the breast. The resident's care plan specifically directed staff to allow her to make decisions about her treatment as able, and to provide reassurance and return later if she refused care or medication. Despite these directives, staff held the resident's hands and administered morphine against her expressed wishes. Multiple staff interviews and employee statements confirmed that the resident was yelling for help and expressing distress, stating she was 'sick of being tied down.' A registered nurse instructed another staff member to hold the resident's hands down while morphine was administered orally, despite the resident's verbal refusal and physical resistance. Witnesses reported that the nurse laughed at the resident's distress and dismissed her complaints, further contributing to the resident's sense of fear and lack of safety. Documentation and interviews indicated that the resident rarely required as-needed pain medication and was generally able to communicate her needs. Staff acknowledged that restraining a resident to administer medication was inappropriate and not in accordance with facility policy. The nurse involved was an agency staff member and was no longer working at the facility at the time of the investigation.