Failure to Provide Ordered Restorative Therapy for Resident with Hemiplegia
Penalty
Summary
A deficiency occurred when the facility failed to provide restorative therapy services as recommended for a resident with a history of hemiplegia, congestive heart failure, and high blood pressure. The resident was discharged from skilled occupational therapy with a recommendation for a Restorative Nursing Program, specifically an active range of motion (AROM) program using bilateral upper extremity weights. The care plan and physician orders specified the use of three to six pound weights for 20 repetitions, three times per session, to be performed three times weekly. However, there was no documentation that these restorative exercises were implemented, and the resident reported not receiving the therapy with weights, despite expressing a desire to participate to improve strength. Interviews with facility staff revealed a breakdown in communication and oversight following staff turnover in the restorative aide position. The restorative aide was unaware of the resident's order for weight exercises, and the Assistant Director of Nursing acknowledged that the order had been overlooked during the transition of responsibilities. The Director of Nursing and Administrator both confirmed that restorative orders are expected to be followed as written, but the lapse was attributed to recent staff changes and oversight.