Failure to Properly Apply and Monitor Hand Splint Resulting in Skin Breakdown
Penalty
Summary
The facility failed to provide appropriate care and services to a resident with severe cognitive impairment and significant physical limitations, specifically regarding the use and monitoring of a right hand palm protector. The restorative nursing assistants (RNAs) did not correctly apply the palm protector as instructed by rehabilitation staff. The elastic band of the device was placed between the thumb and index finger, contrary to the occupational therapist's directions, which was observed to be incorrect and contributed to skin breakdown. Additionally, the RNAs did not inform licensed nursing staff when they observed that the resident's right palm and hand were sweaty and had moisture accumulation, nor did they report the presence of open wounds and bleeding on the resident's right thumb and index finger after removing the palm protector. The wound/treatment nurse was not notified of these wounds, and the resident's care plan and physician orders specifically required monitoring for skin integrity and prompt reporting of any skin breakdown or pain. Observations and interviews confirmed that the resident was dependent on staff for all activities of daily living and had a history of severe contractures and muscle atrophy. Despite these vulnerabilities and clear care instructions, the palm protector was not applied as ordered, and significant changes in the resident's skin condition were not communicated to the appropriate nursing staff, resulting in multiple open wounds and skin issues on the resident's right hand.