Failure to Address Contractures and ROM Limitations
Penalty
Summary
The facility failed to provide appropriate services and interventions for a resident with contractures and limitations in range of motion (ROM). The resident, a male with a history of hemiplegia, hemiparesis, anxiety, major depressive disorder, and muscle wasting, was on hospice services. Despite being identified as having limitations in ROM in both lower extremities and one upper extremity, the facility did not implement a care plan to address these issues. Observations revealed the resident in a fetal position with no splinting devices or positioning aids in place, and staff interviews confirmed a lack of documentation and awareness regarding the resident's contractures. The resident had previously been on and off therapy caseloads, but consistently refused evaluations and services. Occupational and physical therapy records indicated attempts to manage the resident's condition with splints and exercises, but these were met with resistance from the resident. Despite the resident's refusal, there was no documentation of these refusals or any alternative strategies to manage the contractures. Interviews with staff, including the Director of Rehab and the Director of Nursing, revealed a lack of communication and coordination in addressing the resident's needs. The facility's policy on Restorative Nursing Programs was not effectively implemented, as there was no restorative program in place, and staff had not received education on ROM, contractures, or splints. The care plan coordinator confirmed the absence of a care plan for the resident's lower leg contractures, and the Director of Nursing was unaware of the resident's condition. The lack of a coordinated approach and documentation contributed to the failure to provide necessary care for the resident's contractures and ROM limitations.
Plan Of Correction
1: What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice; A. #83 was assessed, and care plan was updated. B. RN unit manager E, Hospice CNA, RN staff B, CNA staff C, care plan coordinator Staff 1, CNA staff A, RN care plan coordinator staff H was educated. 2: How you will identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken; A. Complete audit of resident with Limited ROM and was completed any abnormal findings was corrected. 3: What measures will be put into place or what systematic changes you will make to ensure that the deficient practice does not recur; A. License staff was educated on the documentation of refusal of care, limited ROM and B. Nursing management will review 24-hour report for any refusal of care documentation and ensure and or contractor management are being followed and follow up with any concerns noted. C. Nurse managers will review POC (point of Care) documentation for any refusal or blanks and follow up as needed. D. Nurse Managers will review new admitted residents the following day for any limited ROM and or contractors and ensure appropriate interventions are in place. E. Education for F688 will be provided annually and upon new hire orientation. F. Resident will be screen upon admission and then quarterly by for any decrease in ROM or contractors and appropriate interventions and care plans will be put in place for those residents identified. 4: How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put into place. The Director of Nursing/Designee will audit identified residents with limited ROM or contractors to ensure adequate interventions are followed weekly for four weeks then monthly for one quarter. The Director of Nursing/Designee will submit a report of findings to the Quality Assessment, Assurance and Compliance Committee monthly for one quarter.