Failure to Provide Proper Splint Application and ROM Care
Penalty
Summary
A deficiency was identified when a resident with a history of left hand contracture, hemiplegia, hemiparesis, and left knee stiffness did not receive appropriate care and services to maintain or improve range of motion (ROM) as ordered. Physician orders specified the use of a knee extension splint for the left knee and a resting hand splint for the left hand, with clear instructions on application times and monitoring of skin integrity. Despite these orders, multiple observations revealed that the resident was frequently not wearing the prescribed splints, and when the hand splint was applied, it was often done incorrectly, with the hand roll positioned at the wrist instead of the palm. Staff interviews indicated a lack of awareness and understanding regarding the resident's splint orders. Some staff members were unaware of the need for a knee splint, and others did not know the current status of the orders. The Director of Therapy confirmed that staff are instructed and demonstrated on how to apply the devices, but there were no written instructions or photos available for this resident. The Director of Therapy also noted that the resident experienced discomfort with the leg splint, but the physician's order remained active and was not updated until therapy was completed. Documentation review showed that the CNA Kardex included instructions for both splints, yet these were not consistently followed. Observations over several days confirmed repeated failures to apply the splints as ordered, and when applied, the devices were not positioned correctly. This lack of adherence to physician orders and improper application of splints contributed to the facility's failure to provide appropriate care and services to prevent a decline in the resident's range of motion.