Failure to Provide Ordered Restorative Ambulation Services
Penalty
Summary
The deficiency involves the facility’s failure to provide ordered Restorative Nursing Assistance (RNA) ambulation services to a resident with mobility limitations and a physician’s order for RNA ambulation five times per week. The resident was admitted with diagnoses including unspecified acute kidney failure, difficulty in walking, and generalized weakness, and was assessed as cognitively intact and able to make decisions. The Minimum Data Set indicated the resident required moderate assistance for transfers and walking. The physician’s order recap and the resident’s care plan both specified RNA ambulation with a front wheeled walker as tolerated, five times a week. However, documentation for two consecutive days showed RNA marked as “not applicable.” During interviews, the Director of Rehabilitation confirmed the resident had been on RNA ambulation since late in the month. RNA 1 explained that “not applicable” is used when a resident is not in the facility or is in a general acute care hospital, but the resident was in the facility on at least one of the days in question. RNA 2 stated that on one of those days the resident refused to walk while waiting to be discharged home and was not actually discharged until the following day. RNA 2 further stated that no RNA ambulation was provided on either of the two days, acknowledged that RNA ambulation should have been provided, and that refusals should have been reported to the charge nurse. The DON stated that providing RNA ambulation helps prevent decline in range of motion and ambulation, and that not providing it could result in weakness and possible falls. The facility’s restorative nursing policy required residents to receive restorative care as needed to promote optimal safety and independence, with goals and interventions outlined in the plan of care, which was not followed for this resident on the identified days.
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