| 6128 |
GOOD SAMARITAN SOCIETY - ALBION |
285197 |
P O BOX 271, 1222 SOUTH 7TH STREET |
ALBION |
NE |
68620 |
2015-08-12 |
221 |
D |
0 |
1 |
2LSH11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.05(8) Based on observation, record review and interview; the facility failed to assess the use of a seat belt alarm (a belt attached at the sides of a wheelchair with a velcro closure that is secured around the waist of the seated resident; when the velcro closure is released, an alarm sounds to alert staff the resident has removed the seat belt in an attempt to stand up from the wheelchair) as a potential physical restraint (if the resident is not capable of intentionally removing the seat belt, it is considered a physical restraint) for Resident 50. Facility census was 55. Findings are: A. Review of the facility Procedure for Physical Restraints, issued 2/2013, revealed the following: - A physical restraint is 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 normal access to one's own body. - Physical restraints may include, but are not limited to, using devices in conjunction with a chair such as trays, tables or belts, that prevent a resident from rising. - Remove easily was defined as The manual method, device, material or equipment . can be removed intentionally by the resident in the same manner as it was applied by the staff. - Anytime a device, material or equipment is attached or placed adjacent to the resident's body, a determination will be made by a licensed nurse as to whether it is or could be a restraint for the individual resident. - If the device, material or equipment cannot be removed easily by the resident and restricts freedom of movement or normal access to one's own body, then it is a restraint. - If the device, material or equipment is not a restraint for this resident, then the steps taken to make this decision must be documented, and it must be reviewed with a significant change in condition and quarterly in conjunction with the care plan to ensure that it continues to not be a restraint for the resident. B. Review of Resident 50's Minimum Data Set (MDS-a federally mandated comprehensive assessment tool used or care planning) dated 6/9/15 indicated the resident had [DIAGNOSES REDACTED]. The MDS further indicated the resident had severe impairment of cognitive skills, and problems with inattention (easily distracted, out of touch, or difficulty following what was said) that fluctuated in frequency and severity. Review of Resident 50's current Care Plan with a target date of 12/16/14 indicated the resident was at risk for falls and had a seat belt alarm in the wheelchair as an intervention for fall prevention. The Care Plan further indicated the resident was to demonstrate how to self release the seat belt every shift. Review of the Medication Administration Record [REDACTED]. During observation of nursing care on 8/10/2015 from 11:25 AM until 11:34 AM, Resident 50 was seated in the wheelchair with a seat belt secured at the waist. Licensed Practical Nurse (LPN)-I instructed Resident 50 to release the seat belt. The LPN demonstrated with gestures how the seat belt could be released, but the resident made no attempt to carry out the instructions. During observation of nursing care on 8/10/2015 from 1:15 PM until 1:30 PM, Resident 50 was seated in the wheelchair with a seat belt secured at the waist. Nursing Assistant (NA)-J repeatedly asked Resident 50 to release the seat belt, but the resident made no attempt to follow instructions. During interview on 8/10/2015 at 1:30 PM, NA-J indicated Resident 50's seat belt alarm was initiated because the resident was getting up from the wheelchair and had falls. NA-J further indicated the resident would release the seat belt some days but other days it doesn't sink in. During observation on 8/10/2015 at 1:37 PM, Registered Nurse (RN)-K instructed Resident 50 to release the seat belt. The resident made no attempt to follow instructions. RN-K demonstrated with gestures how the seat belt could be released, attempted to place the seat belt velcro closure in the resident's hands, and repeatedly instructed the resident in this manner. Resident 50 made no attempt to release the seat belt. During interview on 8/10/15 at 1:40 PM, RN-K indicated staff ask Resident 50 to release the seat belt 2 times daily (BID), once on the morning shift and once on the evening shift, and the resident released the seat belt this morning. RN-K further indicated the seat belt alarm was initiated because Resident 50 leans forward in the wheelchair and has had falls in the past. During interview on 8/11/15 between 12:25 PM and 1:40 PM, the Director of Nursing (DON) verified Resident 50's ability to release the seat belt was evaluated BID, and if the resident was not consistently able to demonstrate this, they would reevaluate if the seat belt was needed and/or reassess it as a physical restraint. The DON verified it sometimes required multiple requests during a shift before Resident 50 demonstrated the ability to release the seat belt, and the resident's ability was dependent on mood and time of day. The DON further verified Resident 50's seat belt alarm was reviewed with a significant change in condition and quarterly in conjunction with the care plan to assure it continued to be appropriate and not a physical restraint for the resident. Review of Care Plan Conference Notes and Care Plan Reviews from 9/2014 through 6/2015 revealed no evidence to indicate Resident 50's seat belt alarm was reviewed for appropriateness and/or potential physical restraint except for a Care Plan Review note dated 6/17/15 that indicated wears seatbelt alarm. Is able to show staff every shift (resident) can remove it. |
2019-06-01 |