Failure to Apply Prescribed Splints and Positioning Devices for Residents with Contractures
Penalty
Summary
The facility failed to ensure that two residents with contractures and impaired mobility received appropriate application of prescribed splints and positioning devices as recommended by occupational therapy and documented in their care plans and physician orders. For one resident with severe cognitive impairment, multiple diagnoses including Alzheimer's disease, contractures, and muscle weakness, the care plan and physician orders specified the use of bilateral upper extremity resting hand splints for 4-6 hours daily, with hand rolls as an alternative and regular skin checks. However, over several days of observation, the resident was repeatedly seen without the required splints or hand rolls, and staff interviews revealed confusion about who was responsible for applying these devices and when restorative therapy was provided. Another resident, also with severe cognitive impairment, contractures, and dysphagia, had a care plan and orders for the use of a cockup splint for the left wrist to address contractures. Observations showed the resident without the prescribed splint, with the affected hand and wrist curled to the chest. Staff interviews again indicated uncertainty regarding responsibility for applying splints and the timing of restorative interventions. The facility's restorative nursing program policy required maintenance and restorative services to maintain or improve residents' abilities, but documentation and staff responses indicated a lack of consistent implementation. The deficient practice was further evidenced by gaps in restorative nursing documentation, with progress notes not updated for several months and restorative tasks inconsistently marked as completed. Administrative staff acknowledged the restorative program was being revamped, but at the time of the survey, there was no clear process ensuring that residents with contractures received the prescribed supportive devices and interventions as outlined in their care plans and physician orders.