Failure to Ensure Proper Orders and Consistent Application of Hand/Wrist Splint
Penalty
Summary
A deficiency was identified when a resident with limited movement in the left hand and arm, following a cerebral infarction and with diagnoses including hemiplegia, hemiparesis, and vascular dementia, did not receive consistent application of a prescribed hand/wrist splint. The resident reported that the brace was supposed to be worn in the afternoon and evening but had not been applied for approximately two weeks, not due to refusal but because CNAs had difficulty putting it on. Observation confirmed the resident's left wrist was contracted, and interviews with CNAs revealed they were unaware of any wrist brace for the resident, only acknowledging a brace for the ankle/foot. Review of the resident's medical record showed no physician orders for the hand/wrist splint, and the care plan lacked any focus or interventions related to the splint. The RN confirmed the absence of orders and stated the brace was occasionally applied for comfort, having been provided by the hospice nurse manager. The DON acknowledged that orders should have been in place for the splint and that the care plan should have included this intervention, confirming that the device had been used without proper documentation or physician authorization.