Failure to Consistently Provide Restorative Nursing Programs for Range of Motion and Mobility
Penalty
Summary
The facility failed to consistently provide required restorative nursing programs (RNP) to two residents with orders for interventions to maintain or improve range of motion (ROM) and mobility. One resident, with diagnoses including muscle weakness and difficulty walking, had a physician's order and physical therapy recommendation for ambulation RNP twice daily. However, there was no documentation that the resident was offered the RNP as ordered for 30 consecutive days. Another resident, with anoxic brain damage, persistent vegetative state, and bilateral hand contractures, had orders for passive ROM to the upper extremities and fingers twice daily. Documentation was lacking to show that the RNP was offered as ordered on 18 out of 30 days. Interviews with the Director of Nursing and the Director of Rehabilitation confirmed the absence of documentation supporting that the RNPs were provided as ordered for both residents. The clinical records and staff interviews indicated that the required treatments and services to prevent a decrease in ROM and to maintain or improve mobility were not consistently implemented according to physician orders and therapy recommendations.
Plan Of Correction
Unable to correct past events. Current residents on RNP were reviewed for appropriate documentation to support the offering of RNP as ordered. Current nursing staff re-educated on RNP policy and procedure. Random audits to be completed by DON/Designee to ensure offering of RNP with appropriate documentation x4 weekly x2 monthly and report results to QAPI committee.