Failure to Provide and Document Contracture Prevention and ROM Services
Penalty
Summary
The facility failed to assess, monitor, and implement physician-ordered interventions for a resident with a right-hand contracture. Specifically, the resident had a physician order for a right-hand protector to be applied twice daily to prevent contracture, but the order lacked clear parameters for duration and removal. Observations revealed that the hand protector was not in use, and the resident's right hand was contracted and curled into a fist. There was no documentation in the medical record of any active or passive range of motion (ROM) exercises being performed for the resident's right hand, and the care plan did not address ROM interventions for this condition. Interviews with facility staff indicated a lack of awareness and assessment regarding the use of the hand protector. The MDS nurse confirmed that no quarterly assessments or restorative programs were in place for residents with splints or contractures, and the Assistant Director of Nursing was unaware of the resident's need for a hand protector or who was responsible for its assessment. The facility's policies required maintenance and restorative programs for residents at risk of contractures, but these were not implemented for this resident, who had a history of cerebral infarction, right-hand contracture, and impaired mobility.