Splint Applied Without Physician Order or Schedule
Penalty
Summary
A deficiency occurred when a resident with a right-hand contracture was found to have a resting hand splint applied without a physician's order, therapy instructions, or a documented splint wearing schedule. The resident was moderately cognitively impaired and had functional limitations in both upper and lower extremities. Although the resident had received occupational therapy for two days and was not enrolled in a restorative nursing program, there was no documentation in the medical record or Treatment Administration Record (TAR) regarding the application or removal of a splint. Observations revealed the splint was present in the resident's room on multiple occasions, and interviews with nursing staff indicated that the splint was being applied based on assumptions rather than formal instructions. Nursing staff reported reapplying the splint during their shifts, but acknowledged there was no physician's order or splint schedule, and the application was not documented as a task in the computer system. The resident herself was unaware of the purpose of the splint or when it should be worn. The Therapy Director clarified that the splint had been ordered for use only during supervised therapy sessions, as the resident was not yet able to tolerate it for extended periods. The plan was to provide a physician's order, staff training, and a splint schedule only after the resident could tolerate the splint for more than one hour. Despite this, the splint remained in the resident's room, leading to confusion among nursing staff and resulting in its unsupervised application.