Failure to Implement and Communicate NWB and Immobilizer Orders for Orthopedic Resident
Penalty
Summary
The deficiency involves the facility’s failure to follow physician orders for non‑weight bearing (NWB) status and continuous right knee immobilizer use for a resident admitted with a periprosthetic fracture around an internal prosthetic right knee joint. Hospital discharge summaries directed that the resident remain non‑weight bearing on the right lower extremity, with the knee immobilizer applied full‑time and locked in extension, and that PT perform bed‑to‑chair transfers with the resident remaining NWB. Despite these orders being in place at the time of admission, the resident’s NWB status and immobilizer use were not entered into the physician order sheet or incorporated into the care plan upon admission. Licensed nursing staff later acknowledged that NWB and immobilizer orders were not initiated at admission and that orders for the leg brace to be on at all times and to remain NWB on the right lower extremity with PT bed‑to‑chair transfers were not started until several weeks after admission. Surveyor interviews further showed that direct care staff were unaware of the resident’s immobilizer and weight‑bearing requirements. Two CNAs stated they did not know whether the resident used an immobilizer and were unaware of his weight‑bearing status, and an RNA reported the resident was not on the splint/immobilizer list and that he did not know the resident’s weight‑bearing status. During observation, the resident was noted to have a sign at the bedside stating the right knee immobilizer was to be on at all times, and the resident confirmed that the immobilizer needed to remain on continuously and that he participated in therapy exercises. The DON stated it was important that the immobilizer use and weight‑bearing status be communicated to all staff and that LNs were expected to follow up on orthopedic precautions, but the facility could not provide a policy and procedure for splint/immobilizer use. The surveyors concluded that the failure to carry out NWB and continuous immobilizer orders placed the resident at risk for worsening of the fracture, unsafe movement of the injured limb, potential falls, and additional injury.
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