Failure to Consistently Apply and Document Hand Splints for Resident with Contractures
Penalty
Summary
The facility failed to ensure that a resident with limited range of motion (ROM) received appropriate treatment and services to increase or maintain ROM and prevent further decline, as required by physician orders and facility policy. Specifically, the resident, who had diagnoses including anoxic brain damage and contractures of the upper and lower extremities, was observed multiple times without the prescribed bilateral hand contracture soft splints in place. The resident was dependent for all activities of daily living and was in a persistent vegetative state, requiring staff to provide passive ROM and apply hand splints as ordered. Observations over several days revealed that the resident's hands were consistently found without the soft splints, despite a physician's order for their use and regular checks for fit and skin integrity. Documentation of passive ROM was inconsistent, with some days lacking any record of care, and there was no documentation indicating whether the hand protectors were applied or checked for fit. The care plan did not include specific interventions for checking the placement of the hand splints, and staff training records indicated that staff were instructed to apply the hand protectors daily, but this was not consistently done in practice. Interviews with staff confirmed that the responsibility for applying the splints and providing passive ROM had shifted from a restorative nurse aide to CNAs and the therapy department, following the departure of the restorative nurse aide. Staff acknowledged challenges in applying the splints due to the resident's contractures and occasional removal of the splints by the resident, but also admitted that documentation and consistent application of the splints were lacking. The rehabilitation resource noted that refusals and application of splints were not adequately documented in the care plan.