Failure to Identify and Address Foot Drop and Positioning Needs
Penalty
Summary
A resident with diagnoses including Parkinsonism, scoliosis, and cervical spondylosis with myelopathy was observed to have bilateral limited range of motion in her upper and lower extremities and required substantial to maximal assistance for bed mobility. Despite these conditions, there was no diagnosis of contractures or foot drop documented in her medical records, and her care plan did not address positioning or limited range of motion. Over multiple observations across two days, the resident was consistently found lying on her back in bed with her legs elevated on pillows and her left foot in a plantar flexion position, indicative of foot drop. Staff interviews revealed a lack of awareness regarding the resident's contractures or need for range of motion care, and no orders were in place for repositioning. Further observations noted that the resident remained in the same position for extended periods, and a large blanchable reddened/purple area was observed on her coccyx, with the resident reporting discomfort. The unit manager was unaware of any contractures, and the director of nursing only became aware of the foot drop after hospice staff assessed and documented it. The care plan lacked any focus on positioning or interventions for limited range of motion, and staff reported that such care would only be initiated if ordered by hospice or therapy.