Failure to Maintain Resident's Range of Motion Due to Lapse in Restorative Nursing Program
Penalty
Summary
The facility failed to provide services to maintain or prevent loss of range of motion (ROM) for a resident with multiple diagnoses, including chronic kidney disease, diabetes, dementia, Alzheimer's disease, muscle weakness, and difficulty walking. The resident's care plan identified a need for restorative intervention related to activity intolerance, limited ROM, and limited mobility, with a goal to maintain the current level of function. Recommendations from physical therapy included specific exercises and ambulation routines to be completed five times per week. However, there was no current physician order for physical therapy evaluation or treatment, and the resident's Point of Care (POC) documentation did not list any restorative nursing functions, including ROM or ambulation. Interviews with staff revealed that the facility previously had a restorative aide, but the position was eliminated due to low census, and the responsibility for restorative care was not clearly communicated or assigned to nursing assistants (NAs). NAs reported not being instructed or trained to perform restorative nursing care, and the director of nursing (DON) and administrator acknowledged that the restorative nursing program had stopped when the restorative aide left. Observations showed the resident spent most of the day in a recliner and expressed a desire to walk in the hallway to stay limber, but this was not being facilitated. The facility's policy required restorative nursing care to be provided based on individual needs, but this was not implemented for the resident in question.