A resident reported pain in her shoulder. Bruising was present, and was being investigated as an injury of unknown origin. During the investigation, a CNA reported that three days earlier she had attempted to pull the resident up in bed without assistance and “hurt her real bad.” The resident’s care plan states two person assist for positioning. The CNA did not follow the care plan, and the resident was injured as a result.
To ensure resident care is completed according to facility policies and resident care plans, a system of orientation, education, training, and monitoring is required. Transferring and positioning residents is a routine activity of daily living (ADL) that is completed multiple times a day for each resident. Facility leadership should take steps to ensure that staff are trained and competent in ADL care. A competency based training program as part of employee orientation and annual evaluation is a first step to determining that facility staff are safe to care for residents. This requires building yearly competencies into the facility’s education program. In addition to competency based orientation and training, a monitoring program should be part of ensuring safe resident care. Leadership must audit to ensure that the care provided to a resident is the care that is planned for the resident. Routinely auditing and monitoring care provided by direct care staff is a valuable technique used to ensure safe resident care. If staff understand direct care will be audited by facility leadership through observation, they may be less likely to perform unsafe care practices. Facility leaders need to create a comprehensive orientation, education, training, and monitoring/evaluation program of direct care performance as a beginning step to ensuring safe resident care.
