Failure to Maintain or Improve Residents' Range of Motion and Mobility
Penalty
Summary
The facility failed to provide adequate services to maintain or improve the range of motion (ROM) and mobility for four residents. The facility's policy on Restorative Nursing Services lacked specific guidelines on the frequency and expectations for completing restorative nursing program interventions. This lack of clarity contributed to the failure in implementing the necessary care for the residents. Resident 19 had a therapy restorative referral indicating a decrease in active ROM, requiring passive range of motion (PROM) exercises for their lower extremities. However, the frequency and specific shifts for these exercises were not documented, and the PROM task was only opened for completion during the day shift, leaving evening and night shifts without documentation of completion. Similarly, Resident 48 required ambulation assistance and PROM for their right elbow, but the frequency and specific shifts were not indicated, and the tasks were only documented during the day shift. Additionally, there was a failure to transition from an active ROM program to a PROM program as indicated by therapy. Resident 59's therapy referral indicated a decrease in ROM for their lower and right upper extremities, but the referral incorrectly implemented a program for the left upper extremity. The PROM task was only documented during day and evening shifts. Resident 74 required PROM exercises and orthotic application for their right hand, but the frequency and specific shifts were not indicated, and documentation was lacking for evening and night shifts. There was also no documentation for the application and removal of the orthotic, and several shifts were marked as not applicable or lacked documentation entirely.
Plan Of Correction
1. Residents 19, 48, 59, and 74 had their restorative programs reevaluated. 2. DON/designee audited current residents on a restorative program and were reevaluated with specific frequency. 3. Therapy/licensed staff will be re-educated on providing nursing with a frequency the restorative nursing program should be conducted. 4. NHA/designee will audit 5 random residents receiving restorative services to verify there is a frequency weekly x4 and monthly x3. Results of audits will be reviewed by the Quality Assurance Performance Improvement Committee and changes will be made as necessary.