Failure to Specify Frequency in Restorative Nursing Programs
Penalty
Summary
The facility failed to establish and implement restorative nursing programs with specified frequencies for range of motion (ROM) and mobility interventions for three residents. For one resident with bilateral osteoarthritis of the knee and moderate cognitive impairment, the care plan and therapy recommendations included active range of motion (AROM) exercises but did not specify how often these exercises should be performed. Documentation showed that restorative services were provided inconsistently, and both the resident and the Director of Nursing (DON) confirmed the absence of a defined frequency in the care plan. Another resident, who had a history of stroke with paralysis on one side and was cognitively intact, was assessed as needing restorative ROM and ambulation. The care plan and therapy recommendations listed the types of exercises and ambulation support required but again omitted the frequency for these interventions. Review of the electronic health record indicated that restorative services were provided only once during the review period, and both the resident and the DON acknowledged the lack of a specified frequency for these modalities. A third resident with dementia and total dependence for activities of daily living was also receiving restorative ROM and transfer training. The therapy recommendations described the exercises and transfer activities but did not include directions on how often they should be performed. Documentation showed sporadic provision of these services, and interviews with a family member and the DON confirmed that the frequency was not specified in the care plan. The facility's policy required that restorative nursing plans include the frequency of activities, but this was not followed for these residents.