Failure to Implement and Document Restorative Nursing Program for Resident with Contractures
Penalty
Summary
A deficiency occurred when the facility failed to provide appropriate care to maintain or improve range of motion (ROM) and mobility for a resident with significant functional impairments. The resident, who was in a persistent vegetative state with quadriplegia and contractures, was dependent on staff for all self-care and mobility needs. Occupational therapy discharge recommendations specified daily passive range of motion (PROM) exercises for both upper and lower extremities, as well as a hand splint program with splints to be worn two hours on and two hours off, with palm protectors used when splints were not in place. Despite these recommendations, observations revealed that the resident was frequently found in bed without hand splints or palm protectors in use, and the splints were often seen lying unused on the window ledge. Documentation in the electronic medical record was inconsistent, with several days lacking any record of the restorative nursing program (RNP) being completed, and some staff reporting that they marked the resident as refusing the program when, in fact, they had not attempted to apply the splints due to lack of training. Interviews with staff indicated confusion about the frequency and responsibility for the RNP, with some staff unaware of the specific therapy recommendations or unsure who was responsible for carrying out the program on days when the primary restorative staff member was not present. The care plan for the resident lacked clear direction regarding the RNP and the use of hand splints, and there was no facility policy or procedure for restorative nursing. The task record and treatment administration record (TAR) did not consistently reflect the use of hand splints or palm protectors, and nursing staff did not always review therapy discharge recommendations when setting up the RNP. Family members also reported never seeing the hand splints in use during visits. These actions and omissions resulted in the facility's failure to implement and document the prescribed restorative care program for the resident as recommended by therapy.