Failure to Provide Recommended Active Range of Motion Exercises to Resident's Arms
Penalty
Summary
The facility failed to provide active range of motion (AROM) exercises to both arms for a resident with limited range of motion and mobility concerns, as recommended by occupational therapy (OT) upon discharge. The resident, who had a history of morbid obesity, healed traumatic fracture, and falls, was admitted with specific OT and physical therapy (PT) recommendations for restorative nursing aide (RNA) interventions. The OT discharge summary specifically recommended AROM to both arms, while the PT discharge summary recommended AROM to both legs. However, the resident's care plan and RNA documentation only included active assistive range of motion (AAROM) to both legs, with no mention or documentation of AROM to the arms. Multiple reviews of the resident's records, including the care plan, RNA documentation, and joint mobility assessments, confirmed that AROM to the arms was not provided or documented from January through June. Interviews with staff, including the RNA, interim director of rehabilitation, occupational therapist, and MDS coordinator, revealed that the OT's recommendations for AROM to both arms were not entered into the facility's electronic documentation system by the previous director of rehabilitation. As a result, the RNA program for the resident did not include the required AROM exercises for the arms, despite clear recommendations and supporting documentation from therapy staff. Observations further confirmed that the RNA only performed AAROM to the resident's legs and did not provide any ROM exercises to the arms. The facility's policy on prevention of decline in range of motion required interventions to maintain or improve ROM, but this was not followed in the resident's case. The failure to implement and document the recommended AROM exercises for both arms had the potential to result in a decline in the resident's upper extremity range of motion.