Failure to Provide Consistent Range of Motion Care and Splint Application
Penalty
Summary
The facility failed to ensure that residents with limited range of motion (ROM) received appropriate treatment and services to prevent further decline in ROM for three residents. For one resident with hemiplegia and hemiparesis, staff did not consistently apply the prescribed resting hand splint as ordered by the physician. The resident reported that the splint had not been applied for approximately four months, and when it was applied, no ROM exercises were performed beforehand. The resident also experienced discomfort when the splint was first put on, and staff had to search for the splint in the closet, indicating a lack of routine and consistent care. Another resident with Alzheimer's disease and contractures had physician orders for both therapy evaluation and the application of a hand grip splint. Observations revealed that the splint was not being applied as ordered, as it was seen lying unused on the bedside table during multiple checks. Occupational therapy had recommended consistent use of the splint to maintain function, but there was no evidence of a restorative nursing program or consistent staff follow-through to ensure the splint was used as directed. A third resident with dementia and contractures also had orders for a resting hand splint and passive ROM exercises. Observations showed the splint was not being worn and was found in a chair in the resident's room. Interviews with staff revealed confusion about responsibilities for applying splints and a lack of restorative nursing services in the facility. Staff were unclear about which residents required splints, and there was no established policy or program to ensure the consistent application of splints or provision of ROM exercises, despite physician orders and therapy recommendations.