Failure to Implement Therapy Recommendations and Reassess Mobility Needs
Penalty
Summary
The facility failed to implement occupational therapy (OT) recommendations for hand splints and to obtain physician orders for two residents with significant or developing hand contractures. One resident, who was non-ambulatory and dependent on staff for all activities of daily living, had severe loss of passive range of motion in both hands. Despite an OT evaluation recommending hand rolls for both hands to reduce pain and maintain joint mobility, the resident was not assessed for hand splints, and no physician order was obtained until after the surveyor's visit. Observations confirmed the resident's hands were contracted in a fist position, and the OT acknowledged that the absence of hand splints could worsen the contractures. Another resident with muscle weakness and a history of respiratory failure was also identified as being at risk for contracture development. The OT evaluation recommended resting hand splints for both hands, but the OT did not follow up to obtain a physician order, and the resident had not worn splints for over a month. The resident was observed with contracted fingers and reported not receiving restorative nursing assistance for finger exercises. The facility's policy required the therapist to order splints and ensure physician orders were in place, but this was not followed. Additionally, the facility did not implement its policy for screening and reassessment after a change in condition or readmission for another resident with a history of traumatic brain injury and severe contractures. After readmission, the resident was ordered to receive hand and knee splints, but the rehabilitation department did not formally assess the resident prior to resuming these services. When the resident was unable to tolerate the splints, no new recommendations were made, and the required reassessment was not completed. The facility's policy specified that a PT or OT should complete a joint mobility screening after readmission or a change in condition, but this was not done.