Failure to Implement Contracture Management Program with Splints/Orthotics
Penalty
Summary
A deficiency occurred when a resident with severe upper extremity contractures and cognitive deficits was not provided with the prescribed splints and orthotics as part of her contracture management program. Over a three-day observation period, the resident was repeatedly seen lying in bed with contracted hands and fingers, and at no time were splints or orthotics observed on her or present in her room. Multiple staff members, including CNAs and an LPN, were unaware of any splint or orthotic use for the resident, and there was no documentation on the CNA task sheet or care plan indicating their application. Further investigation revealed that the resident had physician orders and care plan interventions specifying the use of a right elbow extension splint, right resting hand splint, and left palm guard for six hours per day, five days a week, to be applied and removed by nursing staff. Occupational therapy records confirmed the need for orthotic management, and the resident had been referred to Restorative Nursing for ongoing contracture management after being discharged from OT. However, staff interviews and record reviews indicated that these interventions were not being implemented, and there was no documentation of the resident receiving assistance with splints or orthotics, nor any record of refusal. The resident's medical history included diagnoses of dysphagia, contractures in multiple joints, chronic pain, anxiety, and dementia, with substantial assistance required for most ADLs. The facility's own policies required nursing staff to provide restorative services, including splint or brace assistance, and for licensed nurses to oversee and document the effectiveness of such interventions. Despite these requirements, the prescribed contracture management program was not carried out, and the resident did not receive the ordered splinting interventions during the period reviewed.