Failure to Provide Ordered Range of Motion Exercises to Resident's Left Ankle
Penalty
Summary
A deficiency was identified when a resident with a history of malignant neoplasm of the prostate, joint contracture, and muscle wasting did not receive active assistive range of motion (AAROM) exercises to the left ankle as ordered by the physician and recommended by physical therapy. The resident was cognitively intact but required significant assistance with activities of daily living and had documented functional range of motion limitations in one leg. The physician's order specified that a Restorative Nursing Aide (RNA) should provide AAROM exercises to the resident's left leg three times a week. During observation, the resident was unable to move the left ankle independently and expressed pain and difficulty when attempting to do so. While the RNA was observed performing range of motion exercises to the resident's shoulders, elbows, wrists, hands, left hip, and left knee, the left ankle was omitted. The RNA acknowledged during interview that she did not provide ROM exercises to the left ankle, despite being aware of the order and the importance of including the ankle in the exercises for the entire leg. Interviews with facility staff, including the Director of Rehabilitation and the Director of Nursing, confirmed that the RNA program was intended to maintain or improve residents' functional level and range of motion, and that the omission of ordered services could result in a decline in the resident's condition. Review of facility policy indicated that residents with limited ROM should receive treatment and services to prevent further decrease in ROM, but this was not followed in the resident's care.