Failure to Provide and Document Splint Application for Resident with Limited ROM
Penalty
Summary
The facility failed to provide appropriate interventions to maintain or prevent decline in range of motion (ROM) for a resident with a history of stroke resulting in hemiplegia and hemiparesis. Physician orders specified that the resident was to wear a left wrist splint in the morning and remove it at bedtime, and a left ankle splint for six hours daily. Multiple observations over several days revealed that the resident was not wearing the prescribed splints, and the resident reported that splints were only applied during restorative therapy sessions, which occurred twice a week. The resident denied refusing the splints when offered. Interviews with nursing assistants, restorative aides, and nursing staff indicated confusion and lack of clarity regarding responsibility for applying the splints when restorative aides were reassigned to other duties. Documentation review showed that splint or brace assistance was recorded on only seven of the last thirty days, and there was no documentation of splint or brace application in the resident's Medication and Treatment Administration Records for several months. Facility leadership confirmed that nurses were supposed to apply the splints when restorative aides were unavailable, but there was no evidence of this being done or documented.