Delayed Initiation of Restorative Nursing Aide Services for Residents with Limited Range of Motion
Penalty
Summary
The facility failed to provide timely restorative nursing aide (RNA) services for two residents with limited range of motion (ROM), resulting in a delay in the initiation of passive range of motion (PROM) exercises as ordered by therapy staff. For one resident, who had diagnoses including metabolic encephalopathy and polyneuropathy and was assessed with severe cognitive impairment and functional limitations in both upper extremities, there was a documented order for RNA to provide PROM to both upper and lower extremities five times a week. However, the RNA flowsheet showed that no RNA services were provided during the week following the order, and RNA treatment did not begin until several days later, despite the expectation that services should start the day after the order was written. Interviews with staff confirmed the delay and acknowledged that RNA should have started immediately after the order was given. A second resident, with a history of acquired absence of the right leg above the knee and left foot, and moderate cognitive impairment, also experienced a delay in the start of RNA services. This resident had orders for PROM to the left lower extremity and right residual limb five times a week, but the RNA task flowsheet indicated that services were not initiated until several days after the order was written. Staff interviews confirmed that RNA should have started the day after the order and acknowledged the delay in providing the required services. Both residents were identified as being at risk for developing contractures or decreased ROM, with care plans and therapy discharge summaries specifying the need for ongoing RNA services to maintain joint mobility. Facility policy indicated that restorative nursing programs are to be initiated when a resident is discharged from formalized therapy, but in both cases, there was a failure to implement the RNA program as ordered, resulting in a gap in care for residents with limited ROM.