Failure to Implement and Communicate Restorative Nursing Orders for Range of Motion
Penalty
Summary
A deficiency occurred when the facility failed to implement and follow the physician's order for restorative nursing services for one resident with significant medical needs. The resident, who had diagnoses including pneumonia, candidiasis, dependence on a respirator and renal dialysis, gastrostomy, and tracheostomy, was dependent on staff for most activities of daily living. The physician's order required a restorative nursing assistant (RNA) to perform active assisted range of motion (AAROM) exercises to both upper and lower extremities while the resident was sitting at the edge of the bed, three times a week as tolerated. Despite this order, documentation and interviews revealed that the resident was only receiving passive range of motion (PROM) exercises, not the ordered AAROM. The RNA confirmed that PROM was being documented and admitted to not following the specific order for AAROM. The RNA also did not inform the licensed nurse that the resident was unable to perform the AAROM exercises as ordered. The Director of Rehabilitation confirmed that the resident had been discharged from physical therapy and was under RNA services, and that the RNAs were expected to notify nursing staff if the resident could not tolerate the ordered exercises. The facility's job description for RNAs required them to communicate any significant changes in the resident's condition or ability to appropriate staff and to document and report any problems or reassessment needs. However, this communication did not occur, and the licensed nurses were not made aware that the resident was only receiving PROM instead of the ordered AAROM. This failure to follow the physician's order and to communicate changes in the resident's ability to perform exercises constituted the deficiency.