Failure to Provide Appropriate ROM Care and Follow-Up After Knee Surgery
Penalty
Summary
The facility failed to provide appropriate treatment and services to maintain or improve range of motion (ROM) for a resident who had undergone left knee surgery. The resident was admitted with a knee brace in place, but the facility did not obtain a physician order for the use of the knee brace, nor did they develop an individualized care plan addressing its use. Additionally, the facility did not schedule a follow-up orthopedic appointment within the recommended timeframe, resulting in the knee brace being left on continuously for an extended period. Observations and interviews revealed that the resident experienced significant pain and immobility in the left leg, with a pain score of 10/10 upon movement. The resident's medical history included a left tibial shaft fracture, muscle weakness, abnormal gait, and muscle atrophy. Despite recommendations from the orthopedic surgeon for weight-bearing as tolerated and physical therapy, the resident's care plan did not address the knee brace, and there was no documented follow-up with the orthopedic specialist as required. The physical therapy department provided ROM exercises, but the resident was often unable to participate fully due to pain, and the knee brace remained on during all therapy sessions without a physician's directive for its continued use. Multiple staff interviews confirmed that there was a lack of communication and coordination regarding the resident's post-operative care, including the absence of a care plan for the knee brace and failure to clarify or obtain necessary physician orders. The attending physician, DON, and orthopedic physician all acknowledged that prolonged use of the knee brace without proper follow-up could lead to joint stiffness and contractures. Ultimately, the resident developed an equinus contracture of the left ankle and decreased knee mobility, resulting in immobility and pain. The deficiency was attributed to failures in communication, care planning, and timely follow-up with the orthopedic specialist.