F0688

D

Failure to Apply Ordered Hand Splint for Contracture Management

New Castle, Delaware Survey Completed on 12-13-2025

Penalty

No penalty information released

Summary

Surveyors identified a deficiency in the facility’s failure to provide appropriate care to maintain or improve range of motion (ROM) for a resident who required a hand splint. The resident was admitted with diagnoses including anoxic brain damage and persistent vegetative state and was unable to participate in a BIMS assessment due to poor cognition and inability to communicate. The resident’s care plan, dated 10/01/25, documented a need for a splint/brace related to a contracture of the right hand, with instructions for the splint/brace to be applied every day and removed at night. However, review of the physician’s orders dated 12/13/25 showed no provider order for a splint/brace, and review of the record revealed no documentation that the splint/brace was being applied per the care plan.

During multiple observations over several days, the resident was seen lying in bed in a vegetative state and unable to move her body, and on each occasion the splint/brace was not applied to the right hand; instead, it was observed lying on the bedside table. In an observation with a CNA, the CNA confirmed that the splint/brace was not applied and acknowledged it was supposed to be applied during the day every day according to the care plan. In an interview, the DON stated her expectation was that the splint would be applied according to the plan of care to prevent further decline in ROM. The facility’s Splint Issuance Policy required that splints be issued or fabricated with a provider’s order, that a therapist evaluate the patient to determine need, fit, and issuance, and that the splint schedule be communicated to the multidisciplinary team and documented in the care plan, but the resident’s record and observations did not show that the splint was routinely applied as planned.