Failure to Consistently Provide Ordered Range of Motion Exercises
Penalty
Summary
A resident with diagnoses including a stage 4 pressure ulcer, multiple sclerosis, and malnutrition was not consistently offered range of motion (ROM) exercises as part of her restorative nursing program. The resident, who was cognitively intact and able to communicate her needs, reported that staff did not always provide the ROM exercises, which she recognized as important for her condition. Review of task documentation over several weeks showed inconsistent completion of restorative and ROM activities, with numerous entries marked as 'not applicable,' indicating the exercises were not offered or completed during those shifts. Interviews with nursing assistants confirmed that 'not applicable' was used when the task was not offered, often due to lack of time. The director of therapy and the director of nursing both acknowledged the importance of the restorative program and expected staff to follow up when tasks were not completed. Progress notes indicated that the program was not always offered, and the facility's policy stated that restorative programs should be designed according to the resident's goals and abilities. Despite these expectations, the resident did not consistently receive the ordered ROM exercises.