Failure to Implement Individualized ROM Interventions Resulting in Contractures
Penalty
Summary
The facility failed to timely develop and implement comprehensive and individualized interventions to address limitations in range of motion (ROM) and to prevent the onset or worsening of joint contractures for two residents. For one resident with a history of cerebrovascular accident, hemiplegia, and multiple comorbidities, occupational therapy (OT) assessments repeatedly identified limitations in left upper extremity ROM, including the wrist and fingers. Despite these findings and the resident's dependence on staff for activities of daily living, the care plan did not address the identified ROM limitations, risk for contractures, or include an individualized ROM program. After discharge from OT, there was no evidence of ongoing interventions or documentation of ROM services, and observations revealed the resident's arm was fixed in a contracted position, with no staff-provided ROM observed by the resident's spouse. Interviews with therapy and nursing staff confirmed that the resident had not been screened or evaluated by OT since discharge, and functional limitations were not reported by nursing staff. Another resident with a history of cerebellar stroke and contractures was referred to OT for declining upper extremity ROM and contracture prevention. After discharge from OT due to hospitalization, there was no evidence in the medical record of further therapy evaluation, ROM services, or interventions to prevent further decline in contractures for over a year. The resident was dependent on staff for care, had significant upper extremity contractures, and was not receiving any specialized therapies or restorative nursing programs. Interviews with nursing staff confirmed the absence of interventions or splints for the resident's upper extremities, and the resident reported not receiving ROM from staff and being unable to perform basic self-care tasks due to contractures. Both residents' care plans failed to address their upper extremity functional limitations and contracture risks, despite clear documentation of these issues in therapy assessments and resident interviews. The facility did not have a policy regarding ROM or therapy services, and there was no evidence of interdisciplinary planning or implementation of individualized interventions to maintain or improve ROM or prevent further decline. These failures resulted in actual harm, including deterioration in functional ability and pain for at least one resident.