Failure to Implement Ordered Hand Splint/Positioning Device to Prevent Contracture
Penalty
Summary
The deficiency involves the facility’s failure to provide ordered care and services to prevent reduction in range of motion and contracture development for a resident with left-sided weakness and a left-hand contracture risk. The resident had a history of hemiplegia and hemiparesis following a stroke affecting the left nondominant side, and the admission MDS documented a contracture of the left hand with intact cognition. The care plan and physician’s orders directed staff to place a clean, dry, rolled washcloth between the resident’s fingers and palm and ensure good hygiene on every day and night shift. The MAR from late September through early February documented that the rolled washcloth was in place every day and night with no refusals, and progress notes did not document any refusals or missed treatments. Despite this documentation, surveyor observations on multiple occasions showed the resident without any device in the left hand to address contracture risk. The resident was observed in a wheelchair with the left hand hanging down in a loose fist and swollen, and later in bed with the left hand dangling, swollen, and without a rolled cloth or device. The resident reported that therapy had given her a hand device described as a pool noodle with a strap to prevent her hand from contracting and stated she should have been wearing it at the time, but it was observed across the room on her dresser. A therapy consultant reported that an evaluation had been completed for a left-hand contracture, that the resident’s left arm was completely flaccid, and that a simple resting hand splint or rolled towel had been provided for use. Nursing staff and an administrative nurse confirmed that a towel or splint was supposed to be in the resident’s hand at all times and that nurses were responsible for placement and documentation on the MAR. The facility’s restorative nursing policy stated that goals for elders receiving restorative services include preventing contractures.
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