Failure to Provide Ordered Passive Range of Motion Exercises
Penalty
Summary
The facility failed to implement care planned interventions and follow physician orders for passive range of motion (PROM) exercises for a resident with quadriplegia, muscle weakness, major depressive disorder, and contractures of both hands. The resident was dependent on staff for all activities of daily living and mobility, and required a restorative PROM program to prevent further decline in range of motion. Physician orders specified PROM to both upper and lower extremities, 15 repetitions for two sets, twice daily, four to seven times per week as tolerated. However, review of aide charting over a five-week period revealed that PROM was not completed as ordered on multiple days, with only two days showing full compliance. On several days, only one session was completed instead of two, and there was no evidence of follow-up attempts when the resident refused, except on one occasion. Observations and interviews confirmed the deficiency. The resident reported that PROM was often not completed and that he did not refuse the care. A CNA corroborated that the resident's range of motion was limited due to inconsistent implementation of PROM. Another CNA admitted that PROM was sometimes not done due to being understaffed and too busy, and that lack of documentation usually meant the care was not provided. The Director of Nursing stated the resident refused care at times, but there was no documentation to support this for the period reviewed. The facility's policy required restorative programs to be delivered and documented by nursing staff, but this was not consistently done.