Failure to Provide Physician-Ordered Range of Motion Treatment
Penalty
Summary
The facility failed to ensure that a resident with limited range of motion received the physician-ordered treatment and services necessary to prevent further decline in range of motion. Specifically, Resident R15, who was diagnosed with dementia, osteoarthritis, and hypothyroidism, had a physician's order for a left palm protector to be worn at all times except during hygiene activities. However, multiple observations over several days revealed that the resident was not wearing the palm protector as prescribed. The clinical records lacked documentation indicating that the resident was unable to tolerate the palm protector, and staff interviews confirmed that the resident should have been wearing it daily according to the physician's orders. Despite education provided to staff upon the resident's discharge from occupational therapy, the facility did not ensure compliance with the prescribed use of the palm protector, leading to a deficiency in the care provided to Resident R15.
Plan Of Correction
1) R15 to be assessed by therapy to ensure that the resident is receiving the appropriate interventions and therapies. R15 physician order to be changed to specify correct adaptive equipment. 2) Complete facility wide assessment to identify other residents with palm protectors to ensure proper documentation/orders. 3) Provide training to LPNs/CNAS on the importance of palm protectors and documentation of refusals. 4) Restorative Nurse/designee will audit all residents with adaptive equipment with hand contractures for appropriate use and documentation; 1x weekly for 3 weeks then 1x monthly x2. 5) Results of the audits to be reviewed at quarterly QAPI meeting.