Involuntary Seclusion of a Cognitively Impaired Resident in Medication Room
Penalty
Summary
The deficiency involves the involuntary seclusion of a resident with dementia and multiple comorbidities who was placed in the facility’s medication room with the door closed for approximately one and one-half hours due to agitated behaviors and continuous yelling. The resident had diagnoses including dementia, insomnia, end-stage renal disease, failure to thrive, and depression, and was assessed as moderately cognitively impaired, unable to make reasonable and consistent decisions, dependent for all care, and wheelchair bound. The resident’s care plan addressed self-care deficits and mood concerns but did not include interventions involving separation from other residents or placement in a medication room. In the days leading up to the incident, nursing notes documented that the resident frequently yelled out continuously throughout shifts, with some decrease in yelling when brought near the nurse’s station. On the day of the incident, staff reported the resident was anxious, trying to get out of bed, and screaming throughout the shift. A nursing assistant brought the resident to the nurse’s station, and the supervising RN directed that the resident be brought there for closer observation. When the resident’s wheelchair could not be accommodated behind the nurse’s station, the supervising RN placed the resident in the medication room and shut the door, stating it was easier to watch the resident there and to allow other residents to sleep. Written statements and interviews confirmed that the resident remained in the medication room with the door shut, with staff referring to the situation as “solitary confinement” and acknowledging the resident had been yelling all evening. The medication room door was unlocked and had clear glass panels, allowing visual observation, and at some point after midnight, vital signs were obtained and the resident was returned to their room, where they slept for the remainder of the night. The facility’s abuse policy stated that residents would be protected from involuntary seclusion, defined as separation from other residents or the resident’s room against the will of the resident or the resident’s representative. The placement of the resident in the medication room with the door closed for behavioral reasons constituted the separation that led to the cited deficiency.
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