Failure to Provide Consistent Contracture Management for Resident with Limited ROM
Penalty
Summary
A deficiency occurred when a resident with a history of stroke, arthritis, non-Alzheimer's dementia, and left-hand contracture did not receive appropriate interventions to maintain or improve range of motion. The resident was dependent on staff for most activities of daily living and had documented orders for a left-hand brace to prevent further contracture. However, the care plan did not include interventions for the contracture or the use of a brace, and the brace order was discontinued without proper interdisciplinary communication or documentation of medical necessity. Observations revealed the resident was not wearing a splint or brace, and staff interviews indicated confusion regarding the status of the order and the location of the brace. Some staff were unaware of the resident's need for a splint, while others reported the resident had previously used one but was not currently wearing it. The Director of Rehabilitation confirmed the resident required a splint and that the order had been discontinued without his input. The ADON stated the order was discontinued at the request of the resident's family due to poor fit, but could not recall if therapy was consulted before discontinuation. Record reviews showed the resident was listed on the facility's contracture management logs as needing a splint, but the occupational therapy discharge summary did not mention the contracture or splint. The facility's policy required therapy to develop and implement a restorative program upon discharge from therapy, but there was no evidence this was done for the resident. As a result, the resident did not receive consistent or appropriate interventions to address her contracture, as required by her condition and physician orders.