Failure to Implement Splint/Brace Program for Resident with Hand Contractures
Penalty
Summary
The facility failed to implement a splint and brace program for a resident with bilateral hand contractures, as identified through medical record review, observation, staff interviews, and facility policy review. The resident had a history of bipolar disorder, anxiety, depression, suicidal behavior, and contractures, and was dependent on staff for care, bathing, and transfers. Occupational therapy (OT) had previously recommended the use of bilateral hand splints, passive range of motion (PROM) exercises for the left hand, active range of motion (AROM) exercises for the right hand, and verbal cues for self-feeding. However, there were no physician orders in place for the use of splints or for a restorative program involving PROM and AROM exercises. Observation revealed that the resident was not using splints, and interviews with the Therapy Director and Assistant Director of Nursing confirmed that no restorative program had been implemented following OT discharge. The OT had not written orders or completed an evaluation for the implementation of a splint and ROM restorative program, and the nursing restorative staff did not have a program to follow. Facility policy indicated that properly used splints and braces can enhance mobility and protect extremities, but this was not carried out for the resident in question.