Failure to Implement Restorative ROM and Splint Program
Penalty
Summary
A resident with a history of contracture, generalized muscle weakness, and acquired absence of the left hip joint was observed multiple times without the prescribed graded hand roll (hand splint) and without participation in a range of motion (ROM) program. The resident reported that the hand splint was not being applied, and there was no evidence of staff working with their hand. Review of the resident's records confirmed that occupational therapy had established a splint and brace program, including specific instructions for staff to assist with donning and doffing the hand roll and to perform ROM exercises before and after use. The program was to be implemented as a restorative nursing intervention to maintain or improve the resident's ROM and prevent further decline. Despite these documented therapy recommendations, there was no documentation in the orders, care guide, tasks, or care plans indicating that the restorative program had been initiated. Interviews with the DON and the restorative nurse revealed that the therapy-to-restorative recommendation sheet was not communicated to the restorative team, resulting in the resident not receiving the recommended restorative program. Facility policy required that restorative nursing programs be incorporated into the plan of care, but this process was not followed, leading to the deficiency.