Failure to Provide and Monitor Splint Therapy and ROM Services
Penalty
Summary
A deficiency occurred when the facility failed to provide appropriate services to prevent a decline in range of motion (ROM) for a resident with significant physical impairments, including quadriplegia, contractures, and a right upper extremity amputation. The resident was admitted with multiple ROM limitations and was at high risk for contracture development. Orders were in place for the application of multiple splints and for passive range of motion (PROM) exercises to be performed daily by licensed nurses. However, the facility did not ensure that the resident received sufficient physical and occupational therapy services to safely assess and monitor the use of new splints on the left elbow, left hand, both knees, and left ankle. Only one therapy session was provided to assess and fit five new splints, after which the resident was discharged to a nursing maintenance program, despite the complexity and high risk associated with multiple new splints. Observations and interviews revealed that the process for introducing and monitoring new splints was not followed according to professional standards. Occupational and physical therapists indicated that a gradual increase in splint-wearing time, with close monitoring for skin integrity and comfort, was necessary and typically required multiple sessions over several weeks. In this case, the resident received only a single session for all five splints, and therapy staff acknowledged that more sessions were needed to ensure safety and proper fit. The Director of Rehabilitation confirmed that the resident was at high risk for complications and that therapy staff, not nursing, had the expertise to assess splint safety and tolerance. Additionally, the facility failed to provide the left hand splint as ordered by the physician. Nursing staff did not apply the left hand splint for at least two weeks, and there was no documentation or communication regarding the missing splint or the inability to apply it. Interviews with nursing staff and review of medical records confirmed that the left hand splint was not applied as ordered, and there was no record of this omission or notification to the physician or family. Facility policies required the application and removal of splints as ordered and the provision of specialized rehabilitative services for the appropriate length of time, but these were not followed in this case.