Failure to Complete Bed Rail Assessments and Obtain Informed Consent for Bed Grab Bars
Penalty
Summary
The deficiency involves the facility’s failure to complete required bed rail assessments and obtain informed consent prior to installing and using bed grab bars for two residents. Facility policy required that different approaches be tried before using a bed rail and, if a bed rail was needed, that the resident be assessed for safety risk, risks and benefits be reviewed with the resident or representative, informed consent be obtained, and the bed rail be correctly installed and maintained. For both residents cited, surveyors found bed grab bars in use without documentation of informed consent in the electronic medical record and with outdated bed rail assessments that did not support the current use of the devices. One resident had chronic respiratory failure with hypoxia, muscle weakness, chronic pain, intact cognition, and lower extremity range of motion impairment. A quarterly MDS showed he required supervision or touching assistance with bed mobility, was independent with moving from sitting to lying, and did not use bed rails as a physical restraint. During observations, a bed grab bar was seen secured in the upright position on the right side of his bed while he was sleeping and later while he was sitting up eating breakfast. The last bed rail assessment, dated many months earlier, documented that neither the resident nor his representative expressed a desire for an assistive device, that he could independently reposition in bed, and that alternatives to bed rails had not been attempted because a bed rail would promote mobility and transfers. Staff interviews confirmed he used the bed grab bar independently for repositioning and bed mobility, yet no informed consent for its use was found in his record. The second resident had rheumatoid arthritis and lumbar intervertebral disc degeneration with discogenic back and lower extremity pain, intact cognition, and range of motion impairment in both upper and lower extremities. A quarterly MDS indicated he was always incontinent of bowel and bladder, dependent on staff for toileting hygiene, required supervision or touching assistance with rolling, and partial to moderate assistance with position changes, with bed rails not used as a physical restraint. Observations showed bilateral bed grab bars in the upright position, which the resident and staff reported he used only to hold onto while staff rolled him for care, not for independent repositioning. The last bed rail assessment, completed months earlier, documented that neither the resident nor his representative expressed a desire for an assistive device, that he could not rise independently from a supine position, could not reposition himself in bed, had balance and trunk control problems, and that a PT consult had been attempted as an alternative. However, there was no evidence of informed consent for the bed grab bars, and interviews with the DON, Unit Manager, and Administrator revealed uncertainty and lack of awareness regarding assessment frequency and the requirement to obtain informed consent before installation.
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