Failure to Provide Consistent Range of Motion Program
Penalty
Summary
A deficiency was identified when a resident with limited lower extremity range of motion (ROM) did not consistently receive the prescribed ROM program as outlined in her care plan and treatment administration record (TAR). The resident, who was cognitively intact and had diagnoses including chronic respiratory failure, chronic pain, multiple sclerosis, and recurrent bilateral hip subluxations, was supposed to receive assisted lower extremity ROM exercises twice daily. However, documentation over a seven-month period showed that the resident either refused or did not receive ROM for the majority of scheduled opportunities, with some months showing no ROM provided at all. The care plan specified that staff should assist with daily supine ROM and strengthening exercises, and instructions were available both on the resident's bulletin board and in her possession. Interviews with nursing staff revealed that ROM was often not performed, with some staff stating they only moved the resident's legs during other care activities, such as wound care or repositioning. Staff also indicated that the resident frequently refused ROM, but there was no evidence of timely reassessment or communication with the provider regarding these refusals. The director of nursing confirmed the lack of reassessment and acknowledged that the care plan and provider updates were overdue. Facility policy required that restorative nursing programs be individualized and documented in the care plan, with regular assessment by an RN, but these steps were not consistently followed for this resident.