Failure to Implement and Order Therapy-Recommended Splinting Devices
Penalty
Summary
The facility failed to provide appropriate care to maintain or improve range of motion for a resident with significant physical and cognitive impairments. The resident, who had diagnoses including anoxic brain damage, metabolic encephalopathy, quadriplegia, and severe cognitive impairment, was dependent on staff for all mobility and activities of daily living. Occupational and physical therapy discharge summaries recommended the use of multiple splinting devices, including resting hand splints, knee braces, and ankle/foot braces, with specific schedules for their application. However, review of the resident's medical record revealed there were no physician orders in place for any of the recommended splints or braces. Observations showed the resident was not wearing any splints during multiple checks, and the devices were found stored in a box on the floor in the resident's room. Staff interviews confirmed the absence of current orders for splints and indicated that the resident was not routinely offered the devices, despite therapy recommendations and the resident's willingness to use them if offered. Communication between therapy and nursing staff was verbal, and the process for obtaining physician orders and ensuring implementation of splinting schedules was not followed, particularly after the resident's multiple hospitalizations.