Failure to Assess and Maintain Range of Motion for Resident with Hand Contracture
Penalty
Summary
A resident with cognitive impairment and limited functional movement in the right hand experienced a decline in range of motion (ROM) and increased contracture, which was not appropriately assessed or addressed by the facility. The resident, who previously could hold silverware and brush her teeth, was observed to be unable to use silverware and instead used her left hand to pick up food. The resident's daughter expressed concern about the worsening contracture, and staff interviews revealed uncertainty about whether a hand brace was in use, despite its importance in maintaining function and preventing further loss of ROM. A physical therapy (PT) consult was ordered several months prior, but the consult only addressed wheelchair positioning and upper body strengthening, not the ROM needs of the right hand. The PT department had not reassessed the resident since that time, and the assistant director of nursing and physician assistant both acknowledged the significance of a brace for the resident's condition. Facility policy indicated that while therapy services are contracted, the facility retains responsibility for resident care and supervision.