Failure to Provide Ordered Restorative Nursing Care and ROM Interventions
Penalty
Summary
The facility failed to provide appropriate restorative nursing care for a resident with limited range of motion (ROM) and physician's orders for passive ROM exercises and use of a left knee splint. The resident, who was admitted with diagnoses including dementia, generalized muscle weakness, and hemiplegia affecting the left side, was dependent on staff for all activities of daily living and had severely impaired cognitive skills. Physician orders and the care plan specified that passive ROM exercises and application of a left knee splint were to be performed five times a week. Record review and staff interviews revealed that, during a specified week, the resident received passive ROM exercises only three times and had the left knee splint applied four times, rather than the ordered five times per week. Documentation was incomplete, and staff acknowledged that the required services were either not performed or not documented as performed. The Restorative Nursing Assistant (RNA) and Director of Rehabilitation confirmed that the resident should have received these interventions five times weekly, as per physician orders. Observations showed the resident had a contracted left leg, and staff interviews indicated that the lack of consistent passive ROM and splint use could contribute to further decline in physical function. Facility policy required accurate documentation and adherence to prescribed restorative programs, but this was not followed for the resident in question during the reviewed period.