Improper Use of Geri Chair as Bedside Restraint Without Physician Order
Penalty
Summary
Surveyors identified that a resident was not kept free from physical restraints when the resident’s bed was positioned against a wall on one side and a Geri chair was wedged tightly against the bed frame on the other side, creating a physical barrier that restricted the resident’s ability to get out of bed. The resident had been admitted with hemiplegia and hemiparesis following a cerebral infarction affecting the right dominant side, as well as contractures of the right upper arm and right knee. The resident’s history and physical documented that the resident had the capacity to understand and make decisions. The Minimum Data Set showed the resident required substantial/maximal assistance for multiple ADLs, and a fall risk evaluation identified the resident as high risk for falls. The care plan documented the resident was at risk for falls related to confusion and a history of attempting to get out of bed unassisted, with interventions including 1:1 supervision and maintaining constant observation without leaving the resident unattended. During an early-morning observation in the resident’s room, the bed was seen placed against the wall on the left side and the Geri chair was placed directly against the right side of the bed, wedged against the bed frame. The resident was lying in the center of the bed in a fetal position, wrapped in a blanket from head to toe. Interview with the sitter assigned to the resident revealed that the DON had given permission to place the Geri chair next to the bed. An LVN confirmed awareness that the Geri chair was placed against the bed and stated it was being used as a restraint to prevent the resident from rising from the bed because the resident tended to “wiggle out” of bed. The LVN reported that the Geri chair had been in that position since the day shift two days earlier and that both the Administrator and the DON were aware of its use in this manner. Record review showed there was no physician’s order for the use of a Geri chair for this resident, despite its use as a device that restricted the resident’s movement and access to getting out of bed. The facility’s policies on restraint use stated that restraints were to be used only to treat medical symptoms and never for discipline, staff convenience, or fall prevention, and policies on safety and supervision emphasized maintaining an environment free from accident hazards and promoting resident dignity and well-being. In interviews, the RN supervisor, DON, and Administrator each acknowledged that placing the Geri chair against the bed in this way constituted a restraint, could result in entrapment, and was not acceptable, and that other alternatives should have been used instead of using the Geri chair as a restraint for this resident.
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