Failure to Ensure Splint Care Met Professional Standards
Penalty
Summary
The facility failed to ensure that a resident with a volar splint received care in accordance with professional standards and the facility's own policy. The resident, who had Alzheimer's disease and sustained a distal radial (wrist) fracture following a physical altercation, was admitted with a splint on the left wrist. Facility policy required that residents with splints have their affected extremity monitored for circulation, motion, and sensation (CSM), as well as for signs of edema, redness, irritation, or pressure areas, at least every shift. However, record review showed there were no physician's orders in place for monitoring CSM and skin integrity for this resident after the splint was applied. Surveyor observations and staff interviews confirmed that neither the LPN nor the DON were aware of any such orders being in place, despite acknowledging that they should have been. The resident's provider also confirmed the absence of orders for monitoring CSM and skin integrity, although she would not confirm if CSM monitoring was necessary per policy. The deficiency persisted for 13 days after the resident returned to the facility with the splint, until it was identified by the surveyor.