Failure to Apply Ordered Splint for Contracture Management
Penalty
Summary
A deficiency occurred when staff failed to apply a left-hand splint as ordered for a resident with contractures. The resident, who had diagnoses including dementia, contractures of the left wrist and hand, and a history of traumatic brain injury, was care planned and had physician orders to wear a left-hand splint for 4-6 hours daily, with skin checks to be performed after removal. Occupational therapy had previously worked with the resident, and at discharge, the resident was able to tolerate the splint for the required duration. The care plan and restorative program staff were trained to apply the splint, and the resident was dependent on staff for all ADLs. Despite these orders and care plans, multiple observations over several days revealed that the resident was not wearing the splint during various times of the day, both in bed and in a wheelchair. Staff interviews indicated confusion regarding responsibility for applying the splint, with some staff believing it was the responsibility of therapy staff, while others stated that nursing or restorative staff should apply it. The splint was found in the resident's nightstand drawer, and staff did not apply it or notify others about its absence from the resident's hand. Documentation in the Medication Administration Record indicated that skin checks were being documented as completed, but direct observations contradicted this, as the splint was not being applied as ordered. Interviews with the DON and Administrator confirmed that nursing staff were responsible for applying the splint daily, but this was not being carried out in practice, resulting in a failure to follow physician orders and care plan interventions for contracture management.