Improper Restorative Nursing Technique Results in Resident Fracture
Penalty
Summary
The facility failed to provide restorative nursing services as specified in the care plan for a resident, resulting in a fracture. The resident, who had diagnoses including necrotizing fasciitis, osteoarthritis, a previous displaced fracture of the right tibia, and bilateral foot drop, required substantial to maximal assistance for bed mobility and transfers. The care plan and therapy recommendations specified that the resident should perform active range of motion (AROM) exercises independently, with encouragement to spend less time in bed, and did not recommend passive range of motion (PROM) to be performed by restorative aides. On the day of the incident, a restorative CNA was providing range of motion exercises to the resident's lower extremities. During the session, the aide assisted the resident by lifting her right leg and bending her knee, which was not in accordance with the AROM-only recommendation. Both the resident and the aide heard a popping sound, and the resident immediately experienced severe pain. The incident was reported, and initial x-rays were negative, but subsequent evaluation by an orthopedic specialist revealed a closed fracture of the lateral tibial plateau. Interviews with facility staff, including the Director of Rehabilitation and a physical therapist, confirmed that only AROM was recommended and that restorative aides were not trained or authorized to perform PROM. The physical therapist indicated that the aide should not have had hands-on involvement during AROM, and the Director of Rehabilitation acknowledged that PROM could result in fractures, especially in residents with conditions such as osteoporosis or decreased strength. The deviation from the care plan and improper technique during restorative care directly led to the resident's injury.