Unauthorized Modification of Restorative Nursing Program by Unqualified Staff
Penalty
Summary
A deficiency occurred when a Restorative Nursing Assistant (RNA) independently modified a resident's Restorative Nursing Aide program without the appropriate qualifications or authorization. The resident in question had a history of left-sided hemiplegia and hemiparesis following an intracerebral hemorrhage, with additional diagnoses of abnormal posture and muscle weakness. Therapy discharge summaries from both Physical Therapy (PT) and Occupational Therapy (OT) specified a maintenance program involving passive range of motion (PROM) and active assistive range of motion (AAROM) exercises for specific limbs, with clear instructions on frequency and type of exercises to be performed. Despite these instructions, the RNA provided additional exercises and activities not included in the resident's RNA tasks, such as sit-to-stand transfers and use of a motorized exercise bicycle. These activities were not recommended by the PT or OT and were not listed in the resident's care plan or RNA documentation. The RNA acknowledged being aware that these tasks were not part of the assigned program but proceeded to implement them regardless, without notifying the therapy department or a licensed nurse for reassessment or modification of the care plan. Interviews with the RNA, PT, OT, and the Director of Nursing (DON) confirmed that only licensed therapists are qualified to create or modify RNA programs, and that RNAs are required to follow the care plan as written. The facility's policies and job descriptions also supported this requirement. The independent modification of the RNA program by the RNA was identified through observation, interview, and record review, and was determined to place residents at risk for harm and injury due to the potential for inaccurate and inappropriate care.