Failure to Evaluate and Manage Palm Guard Splint Use per Professional Standards
Penalty
Summary
A resident with a history of left-sided hemiplegia and hemiparesis following a cerebral infarction was observed wearing a palm guard splint on the left hand. The resident reported being unable to move the left hand and stated that the splint was worn continuously for extended periods, with no set schedule for removal. Certified Nursing Assistants and nursing staff were unaware of the specific care required for the palm guard splint, including when it should be removed or how to monitor for potential complications. Record review and staff interviews revealed that there was no physician order in place for the use of the palm guard splint, and the device was applied by a Restorative Nurse Assistant without proper authorization. Documentation regarding the application, removal, and monitoring of the splint was lacking, and there was no individualized care plan addressing the use and care of the device. Multiple staff members, including licensed nurses and the Assistant Director of Nursing, confirmed the absence of necessary orders and care planning, and acknowledged the importance of such measures for safe and effective use of the splint. The facility's policy required screening by the rehabilitation team and a physician order for devices other than simple hand rolls, as well as staff in-servicing and documentation in the care plan and daily notes. These procedures were not followed for the resident in question, resulting in a failure to evaluate and manage the use of the palm guard splint according to professional standards of practice.