Failure to Apply Palm Protectors as Ordered for Resident with Contractures
Penalty
Summary
A deficiency occurred when staff failed to apply left and right palm protectors as ordered by the physician for a resident with contractures and impaired upper extremity mobility. Observations showed the resident sitting in the activity room without a palm protector on the right hand, with the hand closed and fingers extended against the palm. Interviews with nursing staff revealed uncertainty about the resident's orders, and both the CNA and restorative aide admitted to forgetting to apply the palm protectors as required. The physician's orders specified that the left palm protector should be on at bedtime and removed in the morning, while the right palm protector should be on at all times except during meals, personal hygiene, and showers. The care plan and MDS documented the resident's severe cognitive impairment, upper extremity impairments, and need for assistance with ADLs due to dementia, stroke, contracture, and possible pain in the hands and fingers. The facility's policy required orthoses to be provided and applied as ordered, with training for all nurses and nursing assistants. Despite this, the palm protectors were not applied according to the physician's orders, as confirmed by staff interviews and direct observation. The failure to follow the prescribed schedule for applying and removing the palm protectors constituted a deficiency in care for the resident, who was at risk for worsening contractures and potential injury to the hands.