Failure to Prevent Decline in Range of Motion Leading to Contracture
Penalty
Summary
A deficiency was identified when a resident with a history of dementia, apraxia, and polymyalgia rheumatica experienced a decline in range of motion (ROM) in the right hand, resulting in the development of a contracture. The facility's policy required that residents not experience avoidable reductions in ROM and that any changes be addressed with appropriate interventions, including therapy referrals and notification of medical providers. Despite these requirements, the resident's medical record did not document any limitation in ROM of the right hand prior to the surveyor's observations, nor was there evidence of timely assessment or intervention as the resident's condition changed. Surveyor observations revealed that the resident was unable to fully extend the third through fifth fingers of the right hand, with visible pain and functional limitations during attempts to open the hand. Interviews with staff indicated a lack of awareness regarding the resident's decline in ROM, and the resident's health care proxy reported noticing the issue weeks prior and informing nursing staff, but no documented follow-up or referral was made at that time. The occupational therapy screen from several months earlier noted full ROM, but no subsequent evaluation was performed until prompted by the surveyor's findings. Further interviews confirmed that key staff, including the unit manager, director of rehabilitation, and nurse practitioner, were not notified of the resident's change in status until the surveyor's intervention. The occupational therapist, upon evaluation, confirmed a new contracture affecting the right hand. The lack of timely recognition, documentation, and intervention for the resident's decline in ROM led to the development of a contracture, contrary to facility policy and professional standards.