Failure to Provide Range of Motion and Contracture Care
Penalty
Summary
A deficiency was identified when a resident with limited mobility and multiple diagnoses, including chronic pain, muscle weakness, and spinal cord disease, did not receive appropriate services to maintain or prevent loss of range of motion (ROM) and contracture care. The resident, who was dependent on staff for lower body dressing and transfers and used a wheelchair for mobility, reported not receiving physical therapy (PT) or occupational therapy (OT) for at least two weeks. The resident expressed frustration, stating that therapy was the primary reason for their stay and that nursing staff were not performing recommended leg exercises in bed. The resident also noted a decline in the ability to straighten her left leg, which she could do prior to admission, and was currently using a Hoyer lift for transfers. Review of the resident's medical record revealed external facility orders recommending daily PT participation while maintaining non-weight bearing status to the left heel, with toe-touch transfers allowed. Despite these recommendations, the resident's care plan lacked evidence of a restorative nursing program or recent PT assessments. Interviews with nursing and therapy staff confirmed that the resident had been discharged from OT and PT and was not receiving any restorative nursing services. Staff also verified that the resident had not been reassessed for PT services after discharge, despite the presence of new orders and ongoing mobility limitations. Further interviews with facility leadership, including the RN manager, director of therapy, and DON, confirmed that communication lapses occurred regarding therapy reassessment and implementation of restorative care. The director of therapy acknowledged that a PT assessment should have been completed, and the DON stated the importance of working with therapy and restorative nursing to prevent unnecessary decline. The facility's policy required timely transcription of treatment orders, but this was not followed, resulting in the resident not receiving necessary services to maintain or improve ROM.