Improper Application of Splints by Untrained Staff
Penalty
Summary
The facility failed to ensure the proper application of a resting hand splint and elbow splint for a resident with limited range of motion as indicated by the physician's order. The resident, who had diagnoses of contracture of the upper arm muscle and right hand, was dependent on staff for most activities of daily living and had severe cognitive impairment. The physician's order and care plan specified that a Restorative Nursing Aide (RNA) should apply the splints to the resident's right arm for four hours daily, five times a week, with skin checks before and after application. However, during observation, a Certified Nursing Assistant (CNA) was seen attempting to reapply and adjust the splints, despite not being trained or authorized to do so. The CNA struggled with the application and later confirmed that it was not within her responsibilities or training to apply splints, which was corroborated by interviews with other staff, including an LVN and an RNA. The facility's policy required that only trained staff, such as RNAs, apply splints and that in-service training be provided for any device ordered other than a simple hand roll. Interviews with staff confirmed that CNAs were not trained to apply splints and could potentially cause harm if they attempted to do so. The failure to ensure that only properly trained personnel applied the splints, as well as the lack of adherence to the physician's order and facility policy, constituted the deficiency identified during the survey.