Delay in Initiation of Restorative Nursing Program After PT Discharge
Penalty
Summary
A deficiency occurred when a resident did not receive timely restorative nursing program (RNP) services following discharge from physical therapy (PT). The resident, who had a history of left lower extremity amputation and used a prosthetic limb, was discharged from PT with orders to begin RNP for active range of motion (AROM) exercises and assistance with transfers and prosthetic management three times a week. Despite these orders, there was a delay in initiating the RNP services, as the resident did not begin receiving restorative care until approximately three weeks after PT discharge. Interviews with facility staff revealed that the delay was due to a lapse in communication and process. The Assistant Director of Nursing (ADON), who is responsible for entering restorative program orders, was out for an extended period, and no alternative process was in place to ensure timely initiation of services. The Rehabilitation Director stated that orders are typically placed in the ADON's mailbox, but there was no backup procedure if the ADON was unavailable. The Director of Nursing confirmed that there is no regulated timeframe for starting restorative services, but acknowledged that the resident should have been placed on the program as soon as possible after PT discharge.