Failure to Provide Timely ROM Interventions and Assessments
Penalty
Summary
The facility failed to provide appropriate treatments and services to prevent a decline in joint range of motion (ROM) and mobility for four residents with limited ROM and mobility. For one resident with hemiplegia and contracture of the left hand, the Restorative Nursing Aide (RNA) program order for ambulation was not updated to reflect the Physical Therapy (PT) recommendation to use a platform walker for stability after PT discharge. Instead, the resident continued to ambulate with a front-wheeled walker, contrary to PT's recommendation. Additionally, this resident did not receive the required quarterly PT and Occupational Therapy (OT) joint mobility screens (JMS) as scheduled. Another resident with dementia and lower extremity ROM impairment did not receive timely RNA treatments for ambulation after PT recommended RNA upon discharge. There was a delay of about three months before the RNA order was implemented. This resident also missed a quarterly PT JMS, which was not completed as required. Interviews with staff confirmed that RNA programs should be initiated immediately after PT or OT discharge and that quarterly JMS are necessary to monitor for changes in ROM and function. Two additional residents, one with multiple sclerosis and functional quadriplegia and another with congestive heart failure and polyarthritis, did not receive their scheduled quarterly PT and OT JMS. Staff interviews revealed that these screenings are intended to monitor joint mobility and identify any changes or declines. The facility lacked a policy and procedure for PT and OT joint mobility screening or monitoring ROM, contributing to the missed assessments.