Failure to Provide Physician-Ordered Anti-Contracture Devices for Residents with Limited ROM
Penalty
Summary
The facility failed to ensure that residents with limited range of motion (ROM) had physician-ordered anti-contracture devices in place as required. For one resident with a contracture of the left hand and wrist due to hemiplegia following a stroke, observations on multiple occasions revealed the resident's left hand was closed in a fist without a palm protector or rolled wash cloth in use, despite a physician's order for a palm protector as tolerated. The care plan indicated the resident sometimes refused the splint but would accept a rolled wash cloth, yet neither device was observed in use. Documentation on the treatment administration record indicated the palm protector was applied, but this was not consistent with direct observations. The Director of Nursing confirmed that staff should not have documented the device as applied if it was not in use. For another resident with a history of dementia, osteoarthritis, and stroke, repeated observations showed the resident's left hand was tightly closed without an anti-contracture device in place. Although there was a physician's order for a hand guard as tolerated, there was no care plan addressing the contracted hand, and no documentation on the administration records of the device being applied or refused. Staff interviews confirmed the resident often refused the device, but there was no system in place to document refusals or alternative interventions. The Director of Nursing acknowledged attempts to use alternative devices in the past, but there was no documentation of their use.