Unauthorized Use of Hand Mitten as Physical Restraint on Ventilator-Dependent Resident
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident’s right to be free from physical restraints imposed for discipline or staff convenience and not required to treat a medical symptom. During an abbreviated survey, a RN observed a resident’s right hand in a mitten with the mitten strap tied to the bed frame. The resident told the RN that someone had tied them. The facility’s restraint policy states that the facility promotes and encourages a restraint‑free environment and that residents have the right to be free from physical restraints used for discipline or convenience. The resident involved had chronic respiratory failure, was ventilator‑dependent, and had moderately impaired cognition per the MDS. The record showed a history of the resident frequently disconnecting the respiratory circuit, with a behavior care plan directing staff to educate the resident on the risks of disconnecting the respiratory circuit and to redirect the resident with television or music. A prior physician order had authorized hand mittens to prevent accidental decannulation with scheduled releases, but that order was discontinued the next day, and there was no active order for mittens at the time of the incident. According to the facility’s investigation and staff interviews, a respiratory therapist placed a mitten on the resident’s right hand and looped the mitten string around the metal bed frame after the resident repeatedly disconnected from the ventilator during the shift. The respiratory therapist stated they did this after finishing rounds and asked another respiratory therapist to keep an eye on the resident while they were gone, stating they did not want the resident to hurt themself. The respiratory therapy director confirmed there was no current order for a hand mitten and that the resident’s behavior of trying to disconnect from the ventilator had been reported on many occasions. The administrator and medical doctor acknowledged that the facility is restraint‑free and that the interdisciplinary team had previously decided against using mittens, opting instead for closer room placement, frequent monitoring, redirection, and psychosocial interventions, yet the mitten was still applied and tied to the bed frame without an active order or adherence to the facility’s restraint protocol. The resident was assessed by nursing and the physician after the mitten was discovered, with no redness, discoloration, trauma, or other visible injury noted, and the resident denied pain or discomfort. Nonetheless, the act of placing the mitten and tying it to the bed frame constituted the use of a physical restraint without following required procedures, including having a current physician order, documented assessment, consent, and defined parameters for use and release. This sequence of events led to the cited deficiency for failure to protect the resident’s right to be free from physical restraints not required to treat a medical symptom.
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