IDPH has cited and fined Charleston Rehab and Health Care Center in Charleston after a resident suffered a fractured arm in a fall from a shower chair.
The resident at issue was completely dependent on the staff for all activities and care, had significant cognitive deficits, and had poor trunk control. Poor trunk control is a contributor to fall risk for residents when they are placed in chairs. This is because they may tilt forward or to the sides and have weight of their torso carry them forward out of the chair or over the sides of the chair. One way of addressing that risk is through the use of a tilt-back wheelchair, a recliner, and ensuring that anything where the resident will be seated has arms. Making sure that this kind of equipment is available for seating the resident is an essential step for preventing nursing home falls in residents with poor trunk control.
On the day of the accident, the resident was brought to the shower and placed in the shower chair using a mechanical lift. The resident began to slide forward out of the chair and to the left. As she did so her arm got caught in the arm rest. She began to demonstrate pain in the arm with some swelling. She was sent to the hospital where x-rays showed that she had a fracture of the humeral head.
This is a resident who had the issues with poor trunk control, cognitive deficits, and had been dependent on staff for everything for a significant period of time. She used a tilt back wheelchair, but the chair that she would be placed did not tilt backwards, did not have a gripping seat, and did not have foot rests which would have helped prevent her from slipping forward out of her seat. Federal regulations require the nursing home to provide supervision and assistive devices necessary to prevent accidents, and for residents such as this one, that would have included a tilting shower chair with the added features intended to prevent falls from the chair.
The nursing home had addressed the deficits that the resident had in her care plan for a well over a year before this injury occurred. At a minimum, this would have included review of the care plan by the care planning team at least four times per year. Despite the fact that the issues of poor trunk control had been present for several reviews of the care plan, the staff failed to consider the need for a chair that would keep her safe while being showered.
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