|§483.10(e) Respect and Dignity. |
The resident has a right to be treated with respect and dignity, including:
§483.10(e)(1) The right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms, consistent with §483.12(a)(2).
The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart. This includes but is not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident's medical symptoms.
§483.12(a) The facility must-
§483.12(a)(2) Ensure that the resident is free from physical or chemical restraints imposed for purposes of discipline or convenience and that are not required to treat the resident's medical symptoms. When the use of restraints is indicated, the facility must use the least restrictive alternative for the least amount of time and document ongoing re-evaluation of the need for restraints.
Based on observation, review of clinical records, facility documentation and facility policy and staff interview, it was determined that the facility failed to ensure that one of five residents reviewed remained free of unnecessary physical restraints (Resident R113).
Review of facility policy "Use of Restraints", undated, indicated "Restraints shall only be used for the safety and well-being of the resident(s) and only after other alternatives have been tried unsuccessfully". ... and ... "Physical Restraints" are defined as any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident's body that the individual cannot remove easily, which restricts freedom of movement or restricts normal access to one's body". "Examples of physical restraint is a soft ties, such as a posey belt".
Continued review of the policy revealed that "Resident or resident's responsible party shall be informed about the potential risks and benefits of all options under consideration, including the use of restraints, not using restraints, and the alternatives to restraint use". "Should a resident not be capable of making a decision, the resident's responsible party may exercise the right of the use of non-use of a resident".
Observation of Resident R113 on May 13, 2019, at 1:45 p.m. revealed the resident sitting in a wheelchair with a posey belt, (a clothe belt-like device applied around the waist and tied behind the wheelchair to prevent the individual from moving and/or sliding out of the wheelchair) secured around the resident's waist. Interview with Resident R113, at the time of the observation, revealed that he could not answer any questions related to the posey belt being in place.
A second observation of Resident R113, on May 14, 2019, at approximately 3:00 p.m. while receiving therapy services revealed that Resident R113, had a Posey belt in place around his waist. Additionally, it was noted that the resident had a seat belt fastened to the wheelchair thereby creating a double restraint for R113.
Interview with Employee E10, Occupational Therapist, on may 14, 2019, at the time of the observation, revealed that the employee was unaware that Resident R113 had a doubled restraint around his waist.
Further observation of Resident R113 on May 14, 2019, at 3:20 p.m. in the presence of the Director of Nursing and Employee E5, Licensed nurse, confirmed that Resident R113 was not properly restrained thereby creating a double restraint, with the Posey belt in place and with a seatbelt fastened to the wheelchair being clipped around R113's waist.
Clinical record review for Resident R113, revealed a physician order, dated, May 1, 2019, which indicated the following diagnoses, respiratory failure, (when not enough oxygen passes from your lungs into your blood), seizure disorder, history of sudden cardiac arrest, non-displaced fracture (broken bone) of 2nd cervical vertebrae and fracture of T11 and T12 vertebra. Continued review of the physician order's dated May 1, 2019, revealed an order dated February 20, 2019, which indicated, "Posey Belt while in chair" and Bilateral Hand Mitts, (glove like device that goes over one's hands, permitting them from being able to use hands) as needed.
Review of Resident R113's quarterly, MDS, (Minimum Data Set - periodic assessment of needs) dated, April 28, 2019, indicated R113 is severly cognitively impaired, requires complete extensive care with all activities of daily living and is impaired on both sides of lower extremities.
Review of facility document "Nursing - Physical Restraint Assessment", dated completed February 26, 2019, revealed an Initial Restraint Assessment for Resident R113 related to the use of a Posey Belt and Hand Mitts. Continued review of the assessment revealed that the section about Resident/family Informed, explained Risks and Benefits of the Posey Belt and/or Hand Mitts restraints was not completed as required by facility staff.
Interview with Employee E5, Licensed nurse, on May 16, 2019, at 10:50 a.m. confirmed that there was no documentation to indicate that Resident R113 and/or family were informed and/or that the risks and/or benefits of the restraints had been explained. Employee E5 further indicated that no documentation was available for review to indicate that the facility re-evaluated the continued need for the Posey Belt and/or Hand Mitts and/or that the restraints were being released every two hours as indicated in the facility policy.
Further interview with the Director of Nursing and Employee E5, Licensed nurse, on May 15, 2019, at 10:50 a.m. indicated that the certified nurse aide, (CNA) assigned to Resident R113 on May 14, 2019, did improperly restrain Resident R113 by placing both a posey belt and a seat belt on Resident R113.
The facility failed to properly use, obtain consent and re-evaluate the need for the continued use of a physical restraint for one resident.
28 Pa. Code: 211.5(f) Clinical records
28 Pa. Code: 211.8(a)(f) Use of restraints
28 Pa. Code: 211.10(d) Resident care policies
28 Pa. Code: 211.12(d)(1)(5) Nursing services
Previously cited 7/24/17
28 Pa. Code: 201.14(a) Responsibility of licensee
Previously cited 7/24/17
28 Pa. Code: 201.18(b)(1)(3) Management.
Previously cited 7/24/17
28 Pa. Code: 201.18(e)(1) Management
| ||Plan of Correction - To be completed: 07/10/2019|
Risks and benefits re-reviewed with the resident's responsible party and documented in the resident's EMR. After review of resident's chart, resident continues to require a physical restraint to ensure the resident's safety.
Audits to be completed to ensure residents' who have physician order for hand-mitt and/or posey pelvic belt have had risks and benefits discussed with resident/resident responsible party as well that a Quarterly Restraint Review has been completed by nursing staff which ensures the continue need for the restraint
Also, posey pelvic belt and hand-mitt orders will be updated to reflect that every two-hour documentation is required for release of the restraint and skin check completed.
Nursing staff will be in-serviced that the new standard order for posey pelvic belts and hand-mitts will include and require documentation every two hours that the restraint was released and skin checks were completed.
DON or designee will audit any order for hand-mitt and posey seat belt to ensure proper documentation in the resident's EMR. Audits will be completed weekly for a month and then monthly for three months.
'Ensure proper restraint use' use will be added to 'Non-clinical Rounds' that are completed weekly by department heads or designees. Audit is to ensure residents are not double restrained or improperly restrained.Data from rounds is captured in QA Steering Meeting.
Audit results for both risk and benefits documentation of restraint documentation and documentation that restraints were released and skin checks were completed will be reported through QA Steering Committee and frequency determined by committee.