Failure to Revise Restorative Nursing Program After New Shoulder Injury
Penalty
Summary
The facility failed to revise the restorative nursing program (RNP) for a resident who was admitted with dementia, a displaced fracture of the upper end of the right humerus, and an unspecified dislocation of the right shoulder. After the resident returned from an acute hospital stay with new diagnoses of right shoulder dislocation and fracture, the RNP plan of care for passive range of motion (PROM) exercises to the upper extremities was not updated to reflect these changes. Physician orders indicated that the right arm should be immobilized and monitored, but the RNP order for PROM to the upper and lower extremities three times weekly as tolerated remained unchanged. Documentation showed that PROM exercises continued to be performed on the resident's upper and lower extremities, with no indication that PROM to the right upper arm was held, despite the presence of an immobilizer and new medical orders. Staff interviews confirmed that the RNP order was not revised, and the restorative nursing team did not review or update the plan after the resident's hospital readmission. The Director of Staff Development acknowledged that the resident should have been referred to physical therapy for screening and that the RNP should have been updated to exclude PROM to the right upper extremity. Further, there was no training provided to Certified Nursing Assistants (CNAs) or Restorative Nursing Assistants (RNAs) on the proper placement of the immobilizer or techniques for positioning and transferring the resident to avoid further injury. The Director of Rehabilitation confirmed that physical therapy did not screen the resident upon readmission, and the Director of Nursing stated that the expectation was for staff to know not to perform PROM on the immobilized arm, even though the order was not updated. Facility policy required screening for mobility status and referral to therapy for any decline, but this was not followed in this case.