Failure to Consistently Provide Restorative Nursing Care for ROM and Splinting
Penalty
Summary
The facility failed to provide consistent and appropriate restorative nursing care to three residents who were enrolled in Restorative Nursing Programs (RNP) for positioning, range of motion (ROM), and hand splinting. Observations, interviews, and record reviews revealed that the facility did not follow the documented care plans for these residents, resulting in missed or incomplete services intended to prevent further decline in ROM and hand contractures. The facility's policy required resident-centered goals and monthly licensed nurse assessments, but these were not consistently implemented or documented. One resident with dementia, osteoporosis, and a history of falls was supposed to receive transfer training, grooming, and ambulation as part of their RNP. However, staff interviews indicated that the transfer program was not being performed as outlined, and there was a lack of measurable goals or instructions. Observations showed the resident was often moved between locations without evidence of the prescribed restorative interventions. Staff cited high turnover and lack of clear direction as contributing factors to the inconsistency. Another resident with contractures, fibromyalgia, and torticollis was to receive passive and active ROM exercises and assistance with dining using adaptive equipment. Observations showed the resident was often left in bed with uneaten meals, and staff reported that restorative aides were not consistently providing ROM or dining assistance. Documentation showed multiple missed sessions, and there was no assessment or summary from licensed nurses regarding the effectiveness of the RNP. A third resident with dementia and muscle weakness was to have a hand splint applied daily, but observations and record reviews confirmed that the splint was not being used, and staff were unclear about their responsibilities for its application and documentation.