Failure to Provide Consistent Orthotic Management for Resident with Limited ROM
Penalty
Summary
A deficiency occurred when the facility failed to provide appropriate care and services related to the management and application of orthotic devices for a resident with limited range of motion (ROM) and reduced mobility. The resident, who had a history of stroke with left-sided weakness and paralysis, type 2 diabetes, and contractures, had physician orders and care plans in place for the use of a palm guard splint to be worn for up to three hours daily. Despite these orders, observations revealed the resident was not wearing the splint on multiple occasions, and the resident reported that her sister had taken the splint home to wash it due to odor, with no clear process in place for cleaning within the facility. The resident also stated she was not receiving restorative nursing services and sometimes had to apply the splint herself, which was difficult and painful. Interviews with staff indicated confusion and lack of clarity regarding responsibility for applying the splint. Certified Nursing Assistants (CNAs) and nurses were both identified as responsible for ensuring the splint was applied, but documentation was inconsistent. The Treatment Administration Record (TAR) showed nurses signed off on the splinting task daily, but CNA documentation frequently marked the task as not applicable, and some days were left blank. Staff interviews revealed that splint application was often not verified before documentation, and some staff were unaware of the resident's need for a splint or that the splint was not present in the room. Further review of therapy and nursing records showed that the resident was not currently on therapy caseload, and the Restorative Nursing Program (RNP) was not active in the facility. Although therapy had provided initial training and recommendations for splint use, ongoing management was left to nursing staff, who did not consistently ensure the splint was available or applied as ordered. There was no documentation of resident refusal to wear the splint, and the care plan for refusal was only recently created without supporting evidence. This lack of coordination and follow-through resulted in the resident not receiving the prescribed orthotic management to prevent worsening of contractures and promote skin integrity.