Failure to Provide Contracture Management for Resident with Limited ROM
Penalty
Summary
A resident with a history of hemiplegia and hemiparesis was admitted with functional limitations in range of motion (ROM) on one side, specifically affecting her left upper extremity. The resident's care plan noted contractures of the left upper extremity and included interventions for skin care, but did not address specific management for her left-hand contracture. There were no physician orders or occupational therapy treatment plans targeting the left-hand contracture, and the occupational therapy evaluation did not provide a specific plan for this issue. Observations revealed the resident had a left-hand contracture with fingers fixed in a closed position and lacked any palm guard or device in place. Therapy carrots, intended for contracture management, were found unused in the resident's room. The resident reported that staff rarely assisted with her hand or trimmed her fingernails, and that the therapy devices were seldom used. Interviews with staff indicated that the resident was not currently receiving restorative care for her contracture, and there was no documentation or plan for contracture management in her medical record. Staff were unclear about responsibility for ongoing contracture care after discharge from restorative services. Further review showed that although a restorative hand program had previously been in place, it was not active at the time of the survey, and the interventions outlined in the program were not being implemented. The DON confirmed that the resident was not receiving restorative care for her contracture and that contracture management was not included in her current care plan. The administrator stated that residents with contractures should remain on restorative care or receive treatment from floor staff, and that failure to do so could result in worsening of the contracture.