Failure to Provide Ordered Restorative Nursing for Upper Extremity
Penalty
Summary
A resident with a history of cerebrovascular accident (CVA), hemiplegia, and hemiparesis had a physician's order for a left upper extremity (LUE) hand orthotic to be worn three to four hours daily as tolerated. The resident's Minimum Data Set (MDS) assessment indicated upper extremity impairment on one side, but did not document receipt of restorative nursing or splint/brace assistance. Multiple observations over several days revealed that the resident did not have the prescribed hand brace on her left hand, and the resident reported rarely wearing the brace and not having worn it in a couple of weeks. Interviews with staff confirmed that the resident received restorative care for her lower body but not for her upper body, and that there was uncertainty among staff regarding whether the resident ever wore the splint. The Director of Health Services confirmed the existence of the physician's order for the left hand splint and stated that staff were expected to ensure the splint was applied as ordered. The failure to provide the ordered restorative nursing intervention had the potential to place the resident at risk for decreased range of motion in her left hand.