| 39 |
RYDER MEMORIAL HOSPITAL INC |
405018 |
355 AVE FONT MARTELO |
HUMACAO |
PR |
792 |
2018-08-16 |
700 |
F |
0 |
1 |
88RA11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff interview the facility failed to assess the residents prior to the installation of bed rails; failed to review the risk and benefits of the bed rails with the residents or resident representatives and failed to obtain informed consent prior to installation of the bed rails. This deficient practice affected 11 (R8, R9, R10, R14, R7, R13, R16, R1, R4, R5, R2) of 11 residents sampled for the use of bed rails. Findings include: 1. On 08/13/18 at 10:21 AM Resident (R) 8 was observed in bed with metal half bed rails in the raised position on the upper portion of the bed. On 08/15/18 at 1:10 PM the bed rails were in the raised position and were inspected with the Director of Nursing (DON). Review of R8's Patient Information sheet indicated the resident had been recently admitted to the facility with a [DIAGNOSES REDACTED]. Review of the Admission Minimum Data Set (MDS) assessment (a resident assessment tool), with an assessment reference date of 08/06/18 revealed a Brief Interview Mental Score (BIMS) score of 7 at Section C, Cognitive Patterns, which indicated that R8 was moderately cognitively impaired. The Nursing Progress Notes from admission through 08/13/18 as well as the entire medical record revealed there was no documentation of an assessment for the use of the bed rails, that facility staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 2. On 08/13/18 at 2:05 PM, R9 was observed in bed asleep with the metal bed rails in the raised position on both sides of the head of the bed. On 08/14/18 at 9:39 AM, R9 was observed in bed with metal bed rails in the raised position on both sides of the head of the bed. Review of R9's Hospital Discharge Summary sheet dated 8/9/18 revealed she was admitted to the nursing facility with [DIAGNOSES REDACTED]. Review of R9's Admission MDS with an assessment reference date of 8/13/18 revealed she was assessed as requiring extensive assistance for bed mobility according to section G, Functional Status. Section C, cognitive patterns indicated R9's BIMS score of 13 which indicated that R9 was cognitively intact. Review of the Nursing Assessment sheets dated 08/09/18 through 08/14/18 as well as the entire medical record revealed there was no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 3. On 08/13/18 at 2:52 PM, on 08/14/18 at 11:22 AM, and on 08/15/18 at 1:10 PM and at 1:46 PM, R14 was observed lying in bed with half bed rails on the top portion of the bed in the raised position. During the observation on 08/15/18 at 1:10 PM the DON verified the top bed rails were used for the resident. Review of R14's Admission Record dated 08/01/18 revealed R14 was admitted to the facility for therapy after she experienced a right [MEDICAL CONDITION]. According to a physician's progress note dated 08/01/18, the resident had [DIAGNOSES REDACTED]. Review of the Admission MDS with an assessment reference date of 08/15/18 revealed the resident was identified as requiring limited assistance with transfers, walking, and locomotion according to Section G, Functional Status. Section C, Cognitive Patters, R14 was documented as being cognitively intact (BIMS score of 13). The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 4. On 08/14/18 at 11:33 AM, R10 was observed in bed with the top bed rails in the raised position. Review of the Physician's history and physical dated 08/06/18 revealed the resident had a [DIAGNOSES REDACTED]. The Admission MDS with an assessment reference date of 08/13/18 indicated that R10 required limited assistance for transfers; required supervision for walking; and as not steady and only stable with staff assistance for moving from seated to standing position, walking, turning around, and for surface to surface transfers according to Section G, Functional Status. The assessment identified the resident as being cognitively intact (BIMS score of 15) at Section C, Cognitive Patterns. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 5. Observation on 08/13/18 at 10:45 AM revealed R1 was in bed with half plastic bed rails at the head of the bed. Interview with R1 and his family at that time revealed he was alert and oriented and used the bed rails for positioning. Review of R1's Patient Information sheet revealed he had been admitted on [DATE] for rehabilitation services post knee replacement. Review of R1's Admission MDS dated [DATE] revealed Section G that R1 required staff assistance for walking, transfer from bed, and moving from seated to standing. According to Section C, R1's BIMS score had not been completed at the time of survey due to his recent admission. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 6. Observation on 08/14/18 at 01:53 PM, R7 was in bed with half metal bed rails in the raised position at the head of the bed. Interview at that time with his wife revealed R7 used the bed rails for positioning. During an observation on 08/15/18 at 1:10 PM, the DON confirmed R7's use of the metal bed rails. Review of R7's Admission MDS, dated [DATE] revealed Section G, R7 required limited assistance of one person for bed mobility. He required extensive assistance of one person to transfer from bed. He required extensive assistance of one person for ambulation. He had range of motion impairment in his upper and lower extremities on both sides of his body. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 7. Observation on 08/14/18 at 1:22 PM, R13 was in bed with metal half side rails in the raised position at the head of the bed. Interview at that time with R13 and her family revealed she was alert and oriented and used the bed rails for positioning. During an observation on 08/15/18 at 1:10 PM, the DON confirmed R7's use of the metal bed rails. Review of R13's Patient Information form revealed she had been admitted on [DATE]. She had been admitted for rehabilitation from a knee replacement. Review of R13's Admission MDS dated [DATE] Section G revealed she required limited assistance of one person for bed mobility. She required extensive assistance of one person for transfers and ambulation. She had limited range of motion in her upper and lower extremities on both sides of her body. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 8. Observation on 08/14/18 at 02:07 PM, R16 was in bed with metal bed rails in the raised position at the head of bed. During an observation on 08/15/18 at 1:10 PM, the DON confirmed R16's use of the bed rails. Review of R16's Patient Information sheet revealed she had been admitted on [DATE]. She had been admitted for short term rehabilitation. Review of R16's Admission MDS, dated [DATE] Section G revealed R16 required limited assistance of one person for bed mobility. She required extensive assistance of one person for transfers and limited assistance of one person for ambulation. She had Range of Motion (ROM) impairment of her lower extremities on one side. She had no ROM issues in her upper extremities. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 9. Review of Resident 2's Admission Sheet, dated 08/15/18, indicated the facility admitted the resident on 07/21/18. R2 had a [DIAGNOSES REDACTED]. Review of R2's MDS assessment, Section G for functional status, indicated he required minimal assistance from staff. R2's BIMS indicated a score of 14, which indicated he was cognitively intact. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 10. Review of Resident 4's Admission Sheet, dated 08/15/18, indicated the facility admitted the resident on 08/07/18. R4 had a [DIAGNOSES REDACTED]. Review of R4's MDS assessment Section G for functional status, indicated R4 required extensive assistance from staff with transfers, bed mobility and locomotion on the unit. R4's BIMS score indicated R4 was severely cognitively impaired. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 11. Review of Resident 5's Admission Sheet, dated 08/15/18, indicated the facility admitted the resident on 07/31/18. R5 had a [DIAGNOSES REDACTED]. Review of R5's MDS assessment Section G for functional status, indicated R5 required extensive assistance from staff with transfers, bed mobility and locomotion on the unit. R5's BIMS score was 11 which indicated he was moderately cognitively impaired. Interview on 08/15/18 at 1:10 PM with the Director stated that all residents in the facility had hospital beds with half bed rails at the head of the bed. The facility's standard practice was to use those bed rails for positioning. It was not the facility's practice to assess residents for use of those bed rails. During an interview on 08/15/18 at 1:20 PM, the DON stated all the beds in the facility are equipped with bed rails. She stated they do not assess the resident prior to placing the residents in the beds with the bed rails. She confirmed that the 11 sampled residents did not have assessments for the use of the bed rails. On 08/15/18 at 3:26 PM, the Administrator was informed that the facility had substandard quality of care related to the widespread use of the half-bed rails without first assessing the residents for appropriate alternatives prior to installing the bed rails; without a system in place to ensure the bed rails were maintained in a safe manner; without assessing the residents for risk of entrapment prior to the installation; without reviewing the risks of bed rails with the resident or resident representative and obtaining informed consent prior to the installation. On 08/16/18 at 9:51 AM Licensed Practical Nurse (LPN) 1 stated when a resident was admitted to the facility the bed was ready with the bed rails are in the raised position. She stated she explains to the resident and any family present that only the top bed rails are to be in the raised position and if the bed has bottom rails attached she tells them do not raise the bottom bed rails because the resident could fall if they attempted to get out of bed. She stated when she leaves the resident in bed alone she ensures the top rails are in the raised position to prevent them from falling out of bed. On 8/16/18 at 10:55 AM, LPN 2 stated when the resident arrives the bed should be ready and that the half bed rails would be in the raised position. She stated the bed rails are left in the raised position to prevent the residents from falling. Review of the facility's policy titled Use of bed rails with a last updated date of 07/14/16 revealed, Standard section of the policy it indicated, the beds in the Skilled Nursing unit will have only two bed rails elevated (in the superior part or the head of the bed) with the purpose of the resident helping themselves to position in bed. No resident will have four bed rails elevated on their bed except those who have a medical justification. Under the procedure portion of the policy it indicated that the nurse or medical professional would educate the resident or family about the standard use of bed rails. During daily rounds, the supervisor would ensure each resident's bed only had the two side rails at the head of the bed in the raised position. The policy did not address that the residents were to be assessed prior to using the side rails. |
2020-09-01 |