Failure to Implement Restorative Nursing Programs for Residents with Limited Range of Motion
Penalty
Summary
The facility failed to implement prescribed restorative nursing programs (RNP) to maintain or improve range of motion (ROM) for two residents with limited mobility. One resident with monoplegia, muscle weakness, and lack of coordination had an occupational therapy recommendation and physician's order for active assisted and passive ROM exercises for the upper extremities. Despite these orders, there was no evidence that staff provided the required RNP, as confirmed by the Director of Nursing and the Program Director of Rehabilitation. The resident was dependent on staff for activities of daily living and had cognitive impairment, with a noted limitation in upper extremity ROM. Another resident with diagnoses including atrial fibrillation and cauda equina syndrome was care planned for passive ROM exercises to the lower extremities. The resident reported that staff did not perform the exercises and that he would not refuse them if offered. Review of the RNP task flowsheet showed that the resident was not offered restorative ROM on 19 out of 30 days. The Director of Nursing confirmed the lack of documented evidence that the RNP was provided as required.