Failure to Update Care Plan for OT Interventions and Hand Splint Use
Penalty
Summary
The facility failed to revise and update a resident's care plan in a timely manner following the initiation of occupational therapy (OT) interventions for hand contractures. The resident, who was non-verbal and required maximum assistance with eating and drinking, was observed with white knit tube stockings on their contracted hands and arms, but was not wearing prescribed hand splints. Review of the electronic medical record revealed that there was no care plan addressing the use of hand splints or OT interventions for the resident's limited range of motion, despite OT involvement beginning over two months prior. The annual MDS assessment, which documented functional limitations in range of motion, had been completed, but the care plan was not updated to reflect the resident's current needs or the OT recommendations. Interviews with the DON confirmed that nursing staff were responsible for applying the splints and that OT had started working with the resident, but interventions such as rolled washcloths were being used instead. The DON acknowledged that interventions for the resident's hand contractures should have been included in the care plan and updated as OT recommendations changed. Further, the Director of Rehabilitation stated that rehabilitation staff had not participated in care plan meetings and that there was no care plan created in collaboration with nursing regarding the hand splints. The lack of an updated care plan persisted throughout the period of OT intervention.