Failure to Provide ROM Interventions for Resident with Contractures
Penalty
Summary
A resident with a history of muscle weakness, chronic fractures, osteomyelitis of the left leg, and contracture of the right wrist was admitted to the facility and identified as having significant range of motion (ROM) limitations in the right hand, right wrist, and left ankle. Assessments, including the Minimum Data Set (MDS) and Joint Mobility Assessment (JMA), documented moderate to severe ROM limitations and contractures, with the resident requiring varying levels of assistance for daily activities. A physician's order was in place for the application of a hand roll to the right hand, but there were no orders or interventions for ROM exercises for the affected limbs. Observations and interviews revealed that the resident's right hand was consistently positioned in a contracted state, with minimal movement possible in the right wrist and left ankle. The Restorative Nursing Aide (RNA) reported only assisting with hand hygiene and application of the hand roll, stating there were no orders for ROM exercises despite believing the resident would benefit from them. The RNA had previously communicated this need to the unit manager, but no action was taken to initiate ROM interventions. The unit manager confirmed that she had not been informed of the need for ROM exercises and agreed that such services were appropriate for the resident's condition. Further review by the MDS Coordinator and Director of Nursing confirmed that the resident was identified as having ROM limitations but was not receiving skilled therapy or restorative nursing services to address these deficits. Facility policy required that residents with limited ROM receive appropriate interventions to maintain or improve mobility, but this was not implemented for the resident in question. The lack of appropriate services and interventions to address the resident's ROM limitations constituted the deficiency.