An Iowa nursing home resident was tied to her wheelchair with a sheet for the convenience of staff. The resident had dementia and severe cognitive issues, and required extensive assistance with transfers, mobility, dressing, toilet use, and personal hygiene.
One evening the resident was restless and not ready for bed, so a certified nurse assistant (CNA) took her to the dining room and informed the two nurses who were there. The CNA said she was in and out of the dining room and at one point heard the nurses complaining that they were not going to get any work done. The nurses asked for a gait belt and then a bedsheet. When the CNA returned a few minutes later, she saw that the resident was tied to her wheelchair with the sheet, which was crossed under her legs and tied to the chair arms. The CNA told another CNA about the resident. That CNA contacted the DON, who initiated an investigation. The CNAs struggled to untie the bedsheet because of how it was woven around the resident.
According to the state inspector’s report, the resident’s care plan notes stated that she was at risk for falls. There were no interventions addressing restlessness or using physical restraints. The two nurses were both suspended pending the investigation.
Nurse 1, when interviewed, said the resident had been agitated and restless that evening so they’d placed a sheet over her to provide comfort. When informed that the sheet was tied to the chair arms, Nurse 1 did not confirm or deny that she was involved with tying the sheet. She said the resident had been sliding out of the wheelchair even though the nurses had used a dycem and one way glide.
Nurse 2 said she’d been involved with putting a sheet over the resident because the resident had been disrobing. She said the sheet might have become tangled up because the resident was restless and moving around a lot. When told the sheet had been tied to the wheelchair, Nurse 2 did not respond to this, but asked if she would be able to come back to finish her scheduled shifts.
The DON’s investigation determined that Nurse 2 was the perpetrator. She was an agency nurse and her contract was not renewed. Nurse 1 was placed under extra supervision and assigned courses on resident abuse to complete. Reeducation was ordered for all staff regarding the use of restraints and what constitutes a restraint.
Compliance Perspective
Issue
Residents should receive kind and considerate care at all times and should be free from mental, physical, sexual, and verbal abuse, exploitation, neglect, and physical injury. Each resident should be free from chemical and physical restraints except as follows: when authorized in writing by a physician for a specified period of time; when necessary in an emergency to protect the resident from injury to the resident or to others, in which case restraints may be authorized by designated professional personnel who promptly report the action taken to the physician; and in the case of an intellectually disabled individual when ordered in writing by a physician and authorized by a designated qualified intellectual disabilities professional for use during behavior modification sessions. Mechanical supports used in normative situations to achieve proper body position and balance shall not be considered to be a restraint.
Discussion Points
- Review your policies and procedures for nursing services and other trained disciplines in providing quality care for residents, supervision and training of staff, and the use of restraints. Also review your policies and procedures for timely and properly reported allegations of abuse. Update policies as needed.
- Train staff regarding restraints, preventing abuse and neglect, and when to report incidents to their supervisor, the state agency, or through the facility’s Hotline. Document that these trainings occurred and file the signed document in each employee’s education file.
- Periodically audit to ensure that staff are aware of what constitutes a restraint, and that any restraint used on residents is authorized by a physician and for the specified period of time. Also audit to ensure that incidents of potential abuse and neglect are fully investigated, documented, and reported to the proper authorities.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
