Failure to Provide and Document Range of Motion Interventions
Penalty
Summary
A deficiency was identified when the facility failed to provide appropriate treatment and services to prevent a decline in range of motion for a resident with limited mobility. The resident, who had a history of right-sided hemiplegia and aphasia following a cerebrovascular event, was dependent on staff for activities of daily living and had documented functional limitations in the upper and lower extremities on one side. The care plan and physician's orders specified that the resident should receive passive range of motion (PROM) exercises and application of a brace to the right side, with specific instructions for timing and monitoring. Despite these documented interventions, observations and record reviews revealed that the resident did not receive the ordered PROM or brace application. The Minimum Data Set (MDS) assessment indicated that the resident had not received passive or active range of motion or brace assistance for at least 15 minutes in the previous seven days. Interviews with staff members, including CNAs and LPNs, showed a lack of awareness or implementation of the prescribed interventions, with one CNA stating that the resident did not have anything in place for the right side at the time of observation, and an LPN not being aware of any device for the resident's right side. Further review of the Treatment Administration Record (TAR) confirmed the absence of documentation that PROM or brace application had been performed as ordered. The Director of Nursing verified the lack of documentation and confirmed that the resident had an active order for these interventions. The failure to provide and document the required care and services led to the deficiency under the federal regulation for maintaining or improving range of motion and mobility.
Plan Of Correction
Preparation and/or execution of this plan does not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth on the statement of deficiencies. This plan of correction is prepared and/or executed solely because it is required. F688 Increase/Prevent Decrease in ROM/Mobility (1) What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice? On , Resident # 31 was assessed by a licensed nurse. No concerns were noted related to the alleged deficient practice. On the order was clarified with MD to indicate donning and doffing of , as well as performing PROM. (2) How you will identify other residents having potential to be affected by the same practice and what corrective actions will be taken, On Audit was completed by Director of Nursing/designee on residents who had orders for /braces to ensure order indicated donning and doffing equipment. Any issues identified were immediately corrected. (3) What measures will be put into place or what systematic changes you will make to ensure that the practice does not recur; By Current Nurses and staff will be educated on the components of F688 with an emphasis on documenting the donning and doffing of a /brace and following the comprehensive resident centered care plan and Prevention of decrease in ROM/Mobility by the DON/Designee. Newly hired licensed nurses/ . Staff will be educated on the components of F688 with an emphasis on documenting the donning and doffing of a /brace and following the comprehensive resident centered care plan and prevention of decrease in ROM/Mobility by the Director of Nursing/Designee at orientation as a part of the systematic changes. (4) How the corrective action(s) will be monitored to ensure the practice will not recur, i.e., what quality assurance program will be put in place: Director of Nursing/Designee to conduct audits of 5 residents with physician orders for a /brace 2x a week for 4 weeks, then 1x a week for 4 weeks and then monthly for 1 month to ensure that the physician order includes documentation of donning and doffing /brace. The findings of these quality monitoring's to be reported to the Quality Assurance/Performance Improvement Committee monthly until committee determines substantial compliance has been met.