Failure to Apply Palm Guard as Ordered and Inaccurate Documentation
Penalty
Summary
A deficiency was identified when a resident with hemiplegia, hemiparesis, and muscle wasting was not provided with a palm guard as ordered by the physician. The resident's medical record indicated a diagnosis following a cerebral infarction affecting the left side, and the resident was assessed as having severe cognitive impairment, requiring substantial or maximum assistance with all activities of daily living. The physician's order specified that the palm guard should be worn daily and removed only for hand hygiene and skin checks. Despite documentation in the Treatment Administration Record (TAR) that staff verified the palm guard was worn daily throughout the month, direct observations on two separate occasions revealed the resident was not wearing the device. The resident reported not often wearing the palm guard but was unsure of the reason. An LPN confirmed the resident was not wearing the palm guard and stated the resident often refused it, yet there was no documentation of refusals or behaviors in the TAR. The TAR continued to be signed off as if the device was applied daily, contrary to actual practice.