Failure to Apply Physician-Ordered Hand Splint for Resident with Limited ROM
Penalty
Summary
A deficiency occurred when staff failed to apply a physician-ordered right-hand splint for a resident with a history of cerebrovascular accident (CVA) resulting in hemiplegia and hemiparesis. The resident had an active order for a right resting hand splint to be worn daily after AM care and removed after PM care, with occupational therapy recommending up to 8 hours of daily use. Despite documentation in the Medication Administration Record indicating the splint was applied, multiple observations over several days showed the resident without the splint, and the device was not present in the resident's room. The resident, who was unable to communicate verbally, indicated through gestures that staff did not apply the splint and that he could not apply it himself. Interviews with staff revealed confusion regarding responsibility for applying the splint. Nurse aides reported not having seen the splint for weeks and believed therapy staff were responsible, while nursing staff thought therapy applied the splint or that the resident removed it himself. The Therapy Director clarified that therapy services had been discontinued and that nursing staff were responsible for the splint application, with education provided at the time of therapy discharge. The Director of Nursing and Administrator both confirmed that nursing staff should have been applying the splint as ordered.