Failure to Follow OT Recommendations and Physician Orders for Splint Application
Penalty
Summary
The facility failed to ensure that occupational therapy (OT) recommendations and care plan interventions regarding the application of splints and braces were followed for three residents with contractures. Physician orders for these residents included the application of specific orthoses to affected limbs daily as tolerated, with skin inspections after removal. However, the orders did not specify the duration for which the splints should be worn, despite OT recommendations and care plans indicating a wear time of four to five hours daily between 7:00 am and 7:00 pm. Observations revealed that the residents were frequently not wearing their prescribed splints or braces during multiple checks throughout the day. Documentation by certified nursing assistants (CNAs) showed inconsistent or minimal application of the splints, with some days showing no application at all and other days showing wear times significantly less than recommended. There was no documentation indicating that the residents refused the splints, and interviews with staff revealed a lack of awareness or training regarding the splint application protocols. Some CNAs and medication aides were unaware of the need for splints, and restorative nursing documentation was either missing or incomplete. The residents involved had significant medical histories, including severe cognitive impairment, contractures of the upper extremities, muscle weakness, and abnormal posture. Despite clear OT discharge instructions and care plan goals to maintain range of motion and prevent further contractures, the facility did not ensure that staff consistently applied the splints as ordered or documented the care provided. The lack of clear physician orders regarding the duration of splint use and the failure to follow OT recommendations contributed to the deficiency.