Failure to Implement and Document Restorative ROM and Splinting Programs
Penalty
Summary
The facility failed to ensure that passive range of motion (PROM) and splinting restorative programs were completed according to therapy recommendations for two residents with impaired range of motion. For one resident with hemiplegia, hemiparesis, and contractures in both hands and wrists, occupational therapy recommended a restorative PROM program and a splint-wearing schedule upon discharge from therapy. However, there were no physician orders or documentation for restorative ROM or splints, and the care plan did not address contractures, PROM, or splinting. Multiple observations confirmed that the resident's hands remained in a contracted position without splints, and interviews with therapy and nursing staff verified that the recommended restorative program and splinting had not been implemented since therapy discharge. Another resident with a history of cerebral infarction, muscle wasting, and contractures was also identified as requiring a PROM restorative program and a splinting program for contracture prevention. The care plan and therapy discharge summary recommended a restorative PROM program and daily use of hand and elbow splints. However, electronic records showed inconsistent documentation of splint application, with several days lacking any record of the splint being applied or refused. Interviews with staff revealed that the facility had recently shifted responsibility for restorative programs from dedicated restorative CNAs to floor CNAs, resulting in issues with program completion and documentation. The facility's policy required that residents at risk for functional limitations receive active or passive ROM to prevent further decline and that staff document all activities, participation, and refusals. Despite these requirements, both residents did not consistently receive the recommended restorative interventions, and documentation was incomplete or missing, leading to a failure to maintain or improve their range of motion as required.