Failure to Provide ROM and Contracture Management for Resident With Functional Quadriplegia
Penalty
Summary
The facility failed to provide appropriate care and services to maintain or improve range of motion for a resident with a right-hand contracture and functional quadriplegia. On multiple observations throughout the same day, the resident was seen lying in bed with the right hand in a contracted position, fingers touching the palm, without any splint or support in place. The resident was unable to verbally communicate but could respond by shaking his head. A neck pillow ordered for positioning was observed lying on top of the sheet over the resident’s stomach rather than being used for its intended purpose. The resident’s records showed an admission with diagnoses including an unspecified displaced fracture of the surgical neck of the right humerus with routine healing, Type 2 diabetes mellitus, right-side involvement, and functional quadriplegia. The MDS documented impairments on one side of the upper and lower extremities and no mobility devices. A therapy funding verification form showed the resident had been approved for PT and OT minutes. Interviews revealed that no discipline had assumed responsibility for managing the resident’s contracted hand or providing ROM as part of daily care. An LPN stated the resident was not receiving ROM or routine care from nursing for the contracted hand and believed therapy was responsible for contractures, explaining that therapy would screen and either continue services or refer to restorative therapy. The restorative therapy staff member confirmed the resident was not on the restorative caseload and had never been referred. The Rehab Director stated he had not screened the resident’s contracted hand and believed nursing was responsible for managing it. The DON stated the resident was admitted with a right-hand contracture and that nursing could not do anything for a contracted hand until therapy evaluated and educated nursing on splint management. The facility’s “Contractures, Prevention” policy required that each resident be evaluated for contracture prevention procedures on admission, readmission, and as needed, and specified that residents with inactive extremities should receive ROM to those extremities as part of daily care, which was not occurring for this resident.
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