Failure to Ensure Use of Prescribed Wrist Splint for Contracture Management
Penalty
Summary
The deficiency involves the facility’s failure to provide and ensure use of a prescribed right wrist/hand splint for a resident with a history of stroke and right-sided weakness, despite facility policy on range of motion and contracture management. The resident was admitted with diagnoses including stroke and right-side weakness, and the care plan identified actual contractures and risk for further contractures related to decreased mobility and right spastic hemiplegia, with an intervention for a resting right hand splint initiated. The resident’s range of motion assessment documented severely reduced right wrist ROM attributed to actual contracture and tone. The resident’s record and RNP task sheet specified that the splint was to be applied on all three shifts. Multiple observations over several days showed the resident in bed without the splint in place, while the splint was repeatedly seen lying on the resident’s wheelchair. A CNA reported never having seen the resident wear a brace, despite knowing the resident’s right arm was weak, and documentation by this CNA indicated the splint had been applied at a time when the resident was observed not wearing it. An LPN stated that the resident does not wear the splint and always refuses it, yet the splint continued to be observed off the resident and on the wheelchair. These observations and interviews demonstrated that the ordered splint was not consistently applied as care-planned and as required by the facility’s ROM/contracture management policy.
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