Failure to Follow Physician Orders for Upper Extremity Orthotic
Penalty
Summary
A deficiency occurred when the facility failed to follow physician orders for an upper extremity orthotic for a resident with a history of stroke and left-sided hemiplegia. The resident was prescribed a left shoulder sling to be worn when out of bed for pain management and support due to shoulder subluxation. Multiple observations showed the resident out of bed and propelling himself in a wheelchair without the prescribed sling, with his left arm appearing edematous and unsupported. The resident reported not having seen the sling since moving units and stated he did not refuse its use. Interviews with nursing staff, including CNAs and an RN, revealed they were unaware of any care planned interventions or orders for the resident's left upper extremity. Review of the resident's care plan showed no interventions for the left upper extremity, despite documentation in the medical record and progress notes indicating the need for the sling and its benefit in managing pain. The nurse practitioner who prescribed the sling confirmed its purpose and the potential for increased pain if not used. The facility's policy on safety device use emphasized the importance of regular checks and proper use of posture devices, but this was not followed in the resident's case. The deficiency was acknowledged by facility leadership during interviews.