Unauthorized Use of Linen as a Physical Restraint
Penalty
Summary
The deficiency involves the use of physical restraints without a physician’s order when a CNA tied a resident to the bed using linen. The resident had diagnoses including schizophrenia and hyperlipidemia and, per a recent MDS, had severe cognitive impairment, required partial/moderate assistance for ADLs such as bathing, and needed supervision or touching assistance for movements like rolling and changing positions. According to the facility’s five-day investigation report, the CNA acknowledged placing linen to the bed of this resident to protect and ensure the resident did not sustain a fall while the CNA attended to another resident. In a later interview, the CNA stated they had tied linen across the resident’s breast and ankles to the bed to ensure the resident would not fall while the CNA was occupied elsewhere. Multiple staff interviews confirmed that using linen in this manner restricted the resident’s movement and constituted a restraint. CNA 1 stated staff should not use an object across a resident’s lap to keep them in bed because it takes away the resident’s right to move, stand, and walk. LVN 1 stated staff should not use linen across a resident because it restricted movement, even if the resident was a fall risk. The PT stated that tying the resident to the bed using linen across the lap was a type of restraint that required a doctor’s order and that the facility does not use blankets as restraints. CNA 2 acknowledged that tying the resident to the bed was a form of restraint and could have affected the resident’s dignity, and that they should have called other staff for help instead. The DON, referencing the facility’s Restraints and Resident Rights policies, stated that CNA 2 did not follow policy by not honoring the resident’s right to move freely, and the written policies indicated residents have the right to be free from restraints imposed for reasons other than treatment of medical symptoms and to be treated with kindness, respect, and dignity.
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