Failure to Consistently Apply and Document Splint Use for Resident with Limited Mobility
Penalty
Summary
A deficiency occurred when the facility failed to ensure that a resident with a history of stroke and left upper extremity paralysis consistently received splint application as outlined in her restorative care plan. The care plan required daily application of a palmar grip splint to the resident's left hand for two to four hours, with the goal of maintaining range of motion and preventing contractures. Documentation showed that the splint was applied inconsistently, with recorded application times significantly less than the prescribed duration and on an irregular schedule. Observations revealed that the resident was not wearing the splint during several visits, and both the resident and her Power of Attorney reported that the splint was not applied consistently. The resident was unsure of the splint schedule, and her Power of Attorney, who visited almost daily, stated he rarely saw the splint in use and was not informed of a schedule. Staff interviews confirmed a lack of awareness regarding the splint application, with some staff unaware of the need for the splint and others unable to recall seeing it applied until prompted by the survey. Further review indicated that although the facility's policy required documentation of restorative care interventions in the electronic medical record, this was not consistently done. The Director of Nursing and other staff members acknowledged gaps in communication and responsibility for splint application, with uncertainty about which staff were responsible for the task. The resident's occupational therapy notes emphasized the importance of regular splint use to prevent further contracture, but this was not consistently implemented by the nursing staff.