Failure to Apply Ordered Hand Splints for Resident with Contractures
Penalty
Summary
Staff failed to provide ordered care for a resident with decreased range of motion by not applying physician-ordered splints to both hands. The resident, who has a history of multiple chronic conditions including metabolic encephalopathy, chronic obstructive pulmonary disease, chronic kidney disease, osteoarthritis, and diabetes, was observed on two occasions without the required hand splints. Observations noted contractures in both hands, with fingernails on the left hand digging into the palm, and the resident was unable to open her hands. Additional observations included matted hair, dry and flaky skin, and long fingernails with brownish substances underneath. The resident's care plan and physician orders specified the use of palm protectors for both hands for at least 2-4 hours daily or as tolerated, with staff responsible for assisting with their application and monitoring for skin concerns. Interviews with staff revealed a lack of awareness and follow-through regarding the splint orders. The assigned LPN was unaware of the need for hand splints, and the restorative aide admitted to not providing restorative care on the day prior to the survey and was unsure of the whereabouts of one of the splints. The restorative aide confirmed that all staff were supposed to assist the resident with the splints, but this was not consistently done. Facility policy required assessment and provision of restorative services, including contracture management and splint use, but these were not implemented as ordered for this resident.