Failure to Provide Ordered Range of Motion Exercises to Both Upper Extremities
Penalty
Summary
A deficiency occurred when a resident with osteoarthritis and chronic obstructive pulmonary disease, who had moderate cognitive impairment and decreased range of motion (ROM) in both upper extremities, did not receive the ordered active assisted range of motion (AAROM) exercises to the left upper extremity during a restorative nursing aide (RNA) session. The resident's care plan and physician orders specified that AAROM exercises were to be performed on both upper extremities daily to maintain or improve ROM and prevent further decline. However, during observation, the RNA only performed exercises on the right upper extremity and applied a splint, omitting the left side entirely. The RNA later acknowledged that the omission was due to the belief that the resident could move the left upper extremity independently, despite the care plan and orders requiring assistance for both sides. Interviews with facility staff, including the Director of Rehabilitation and the Director of Nursing, confirmed the importance of following RNA orders to prevent decline in mobility and function. Facility policy also required that restorative nursing care be provided as needed to promote optimal safety and independence, which was not followed in this instance.