Failure to Provide Prescribed Splinting and Restorative Care for Contracture Management
Penalty
Summary
A deficiency was identified when a resident with contractures in both hands was not consistently provided with the prescribed carrot hand splints intended to prevent further worsening of contractures. During multiple observations over three days, the resident was found in bed without the carrot splints in place, except for one instance. The resident reported that staff never put the splints on or provided hand exercises. The care plan, physician orders, and occupational therapy recommendations all specified the use of bilateral carrot splints for up to eight hours daily, with skin integrity checks before and after use. The facility's electronic records and task lists for CNAs also documented the requirement for passive range of motion (PROM) exercises and splint use as part of the resident's restorative care. Despite these documented requirements, the splints were not observed on the resident during most surveyor visits, and the resident confirmed a lack of consistent application and exercises. The LPN/Restorative Nurse acknowledged that CNAs were responsible for providing restorative care and applying the splints, but this was not being carried out as ordered. The resident's diagnoses included multiple sclerosis, dementia, and other conditions contributing to upper extremity impairment, making adherence to the prescribed interventions critical for contracture management.