Failure to Update Care Plan for Resident’s Regular Wheelchair Seat Belt Use
Penalty
Summary
Surveyors identified a deficiency in the facility’s failure to review and revise a comprehensive care plan to reflect a resident’s regular use of a wheelchair seat belt. The resident had multiple neurologic and functional impairments, including traumatic subarachnoid hemorrhage with loss of consciousness, lack of coordination, abnormal posture, hemiplegia on the right dominant side, history of traumatic brain injury, aphasia following cerebral infarction, and contractures of the right elbow, wrist, and hand. The quarterly MDS showed the resident was cognitively intact with a BIMS score of 13/15, had functional limitations in bilateral upper extremity range of motion, used a motorized wheelchair, and required substantial/maximal assistance for bed mobility and transfers. The comprehensive care plan, initiated on admission and revised at later dates, identified an ADL self-care performance deficit related to right hemiparesis and documented use of a power chair with a back cushion for safety, comfort, and independence, but did not include any problem or intervention related to the use of a seat belt. During multiple observations on different days, the resident was repeatedly seen seated in a motorized wheelchair with a seat belt on. Review of the EMR by the RN/Unit Manager confirmed there was no physician order for a wheelchair seat belt and no care plan addressing seat belt use. The MDS Coordinator stated they did not capture seat belts on the MDS because they believed rehabilitation assessed residents and that residents would be capable of removing the belts, and acknowledged they did not review those assessments. The MDS Coordinator further stated they would expect staff to check positioning, security, and the resident’s ability to remove the belt, and confirmed such interventions should be identified in a care plan. The DON acknowledged that wheelchairs should be assessed on admission and quarterly and that the seat belt should be part of the care plan, and also confirmed there was no specific policy for care plan revisions, only a general comprehensive care plan policy. The facility’s care planning policy required that comprehensive care plans be developed, reviewed, and revised by the interdisciplinary team after each assessment, but this was not done for the resident’s seat belt use.
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