Failure to Provide Ordered Restorative Nursing Care to Residents with Mobility Impairments
Penalty
Summary
The facility failed to provide restorative nursing care (RNA) as ordered for four residents with significant mobility and functional impairments. For one resident with a right leg amputation and artificial hip, the care plan and physician orders required active range of motion (AROM) exercises three times a week to prevent decline in muscle strength and contractures. However, the resident did not receive any RNA therapy since January, despite no documented medical reason to withhold therapy. The restorative nursing assistant was unaware of the order, and the Director of Rehabilitation did not follow up with the physician or ensure the therapy was provided. Another resident with hemiplegia, paraplegia, and multiple contractures was ordered to receive passive range of motion (PROM) exercises for both upper and lower extremities three times a week. The resident only received RNA for upper extremities once a week and did not have a brace or splint for contracted hands, despite expressing a goal to regain self-feeding and oral care abilities. The restorative nursing assistant and occupational therapist confirmed the lack of appropriate therapy and equipment, and the Director of Rehabilitation was unaware of the incomplete RNA provision. A third resident with gait abnormalities, right knee contracture, and hemiplegia was ordered to receive RNA for bilateral upper extremities twice a week and PROM three times a week. The resident only received RNA for lower extremities, as the restorative nursing assistant did not review the orders for upper extremity therapy. The Director of Rehabilitation and DON were not aware of the missed therapy. Additionally, a fourth resident with cellulitis and mobility issues was discharged from physical therapy due to insurance coverage ending and was not evaluated for or provided RNA, despite expressing a desire to regain strength and being instructed to use a wheelchair instead of a walker. The Director of Rehabilitation confirmed that the resident should have been encouraged to ambulate with a walker and that no RNA eligibility assessment was performed.