Failure to Apply Physician-Ordered Palm Guard for Resident with Contractures
Penalty
Summary
A deficiency occurred when staff failed to apply a physician-ordered right-hand palm guard (green carrot) for a resident with a history of cerebral infarction, hemiplegia affecting the left side, contractures, and cognitive communication deficit. The order specified that the palm guard should be placed on the resident's right hand at night and removed in the morning. However, observations and interviews revealed that the device was not applied as ordered, and there was no documentation of refusal by the resident. Record reviews showed that the order for the palm guard was not present on the Medication Administration Record (MAR) for April and part of May, and there was no documentation in the nursing progress notes regarding the resident's refusal to use the device. Staff interviews indicated confusion about which shift was responsible for placing and removing the palm guard, and some staff were unaware of the resident's needs or the location of the device. The palm guard was found in the resident's nightstand rather than in use, and the resident confirmed that it had not been applied as ordered. Further interviews with nursing assistants, the unit manager, and the DON confirmed that the palm guard was not consistently applied or documented. The occupational therapy director stated that the nursing staff had been in-serviced on the use of the device, but the resident was not currently on therapy caseload. The lack of application and documentation of the palm guard represented a failure to provide appropriate care to maintain or improve the resident's range of motion and prevent complications associated with contractures.