Failure to Follow Physician Orders and Care Plan for Splint Application
Penalty
Summary
A deficiency occurred when staff failed to follow physician orders and the care plan for a resident with hemiplegia, hemiparesis, vascular dementia, and pseudobulbar affect, who required a splint for the left upper extremity. The physician's order specified that the splint should be applied upon rising, removed for lunch, reapplied after lunch, and removed at bedtime, as tolerated by the resident. Multiple observations revealed that the resident was not wearing the splint at the required times, and the resident reported that the splint was never applied and was unaware of its location. The splint was later found in the resident's drawer, and the resident allowed it to be applied without resistance. Documentation showed that there were 21 instances where the splint application did not occur, with no follow-up documentation by licensed staff to address refusals or investigate the root cause. The care plan indicated that if the resident refused, staff should encourage compliance and document refusals, but there was no evidence that this was consistently done. Interviews with staff confirmed that the care plan was not followed, and communication regarding refusals was lacking.