Failure to Provide Ordered Splinting and ROM Care for Multiple Residents
Penalty
Summary
The facility failed to provide treatment and care in accordance with professional standards of practice for three residents who required range of motion (ROM) and orthotic devices. The facility did not have policies for splinting/orthotic devices or for Restorative Nursing Services, as confirmed by the Administrator. Staff interviews revealed a lack of clarity regarding responsibility for applying splints and performing ROM, with some staff unaware of which residents required these interventions or how to document them. One resident with hemiplegia and hemiparesis had a physician order for a resting hand splint to be applied daily, but reported that the splint had not been applied for about four months and that ROM was not performed prior to application, causing discomfort. Another resident with dementia and contractures had a splint order, but repeated observations showed the splint was left unused on the bedside table over several days. A third resident with dementia and contractures also had a physician order for a hand splint, but was repeatedly observed without the splint in place, and staff documentation showed inconsistent application. Interviews with CNAs, a CMT, and the Director of Rehabilitation indicated confusion about who was responsible for applying splints and performing ROM, with some staff stating that there was no restorative nursing program and that ROM was only provided during ADL care. The DON and Administrator acknowledged the lack of a restorative program and emphasized the expectation to follow physician orders, but confirmed that residents were not consistently receiving the ordered care.