Failure to Provide PROM Exercises as Recommended by PT
Penalty
Summary
A deficiency occurred when a resident with left-sided hemiplegia and hemiparesis, following an intracerebral hemorrhage, did not receive passive range of motion (PROM) exercises to the left leg as recommended by physical therapy. The resident's physical therapy evaluation documented no strength in the left hip, knee, and ankle, and the discharge summary specifically recommended a restorative nursing aide (RNA) program to provide PROM to the left leg and active assistive range of motion (AAROM) to the right leg. However, review of the RNA documentation for the relevant month showed that PROM exercises for the left leg were not included in the RNA task list, and staff confirmed this omission during interviews. The physical therapist acknowledged forgetting to input the PROM task for the left leg, despite its importance for the resident, who was unable to move the left leg independently. Observations of the resident revealed significant physical limitations, including inability to move the left arm and leg, and abnormal positioning of the left limbs. The resident was cognitively intact and required varying levels of assistance for activities of daily living, with documented functional range of motion limitations in one arm and one leg. The facility's policy required that residents with limited ROM receive appropriate treatment and services to prevent further decline, but this was not followed in this case, as the recommended PROM exercises were not implemented.