Failure to Obtain Physician Order and Assessment for Non-Self-Releasing Restraint
Penalty
Summary
The deficiency involves the facility’s failure to obtain a physician order and complete an assessment for the use of a non-self-releasing physical restraint on a resident with severe cognitive impairment. The resident’s MDS documented severe cognitive impairment and dependence or significant assistance needs for toileting, bed mobility, transfers, bathing, dressing, and personal hygiene. The care plan and related documentation, including a physician order sheet and physical device evaluation, specified the use of a self-release belt when the resident was up in a wheelchair, to be released during rounds, ADLs, meals, supervised activities, and as needed. A restraint consent documented verbal consent for a soft belt restraint, but the EMR did not contain a physician order or assessment specifically for a non-self-releasing seat belt. Surveyor observations on multiple days showed the resident seated in a wheelchair on a pommel cushion with a cloth lap belt whose long straps were tied to the bottom of the back of the wheelchair, and the belt was not self-releasing. When asked to remove the belt, the resident was unable to do so and expressed dislike for it. The resident’s regular RN reported that the resident previously used a front-latch belt that could be self-released, but the facility changed to a soft belt the resident could not remove due to frequent falls. The DON confirmed that the resident had multiple falls, that the resident and family agreed to use a non-self-releasing belt, that the change to this belt occurred months earlier, and that the resident could not release it. The DON also confirmed there was no physician order or assessment in place for this non-self-releasing physical restraint, despite facility policy requiring assessment of alternatives, physician and POA notification, consent, and ongoing review before and during restraint use.
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