Failure to Provide Preventive Care for Resident with Limited Range of Motion
Penalty
Summary
A resident with a history of quadriplegia, bipolar disorder, and seizures, and who was assessed as having severely impaired cognition and limited range of motion (ROM) in both upper and lower extremities, did not receive appropriate preventive care measures to maintain or improve ROM and prevent further contractures of the hands. Physician orders and occupational therapy recommendations specified the use of resting hand splints and palmar guards for set periods to reduce pain and improve passive ROM, and the care plan included the use of pressure-reducing products such as hand rolls. However, multiple observations over two days revealed that the resident consistently did not have any hand contracture devices in place, and the resident's fingernails were noted to be long and dirty. Interviews with nursing and rehabilitation staff confirmed that the resident was not provided with the recommended hand devices, and there was a lack of clarity and follow-through regarding responsibility for ensuring these interventions were implemented. The Director of Rehab Services stated that the facility did not have a restorative care program at the time, and both the LVN and DON acknowledged that it was the responsibility of nursing staff and CNAs to ensure the use of hand rolls and proper nail care. Facility policy required residents with limited ROM to receive treatment and services to prevent further decline, but these measures were not provided for this resident.