Failure to Assess and Provide Restorative Care for Hand Contracture
Penalty
Summary
The deficiency involves the facility’s failure to assess and address a resident’s restorative needs related to a left-hand contracture. During observations on two separate days, the resident was seen in a wheelchair with the left wrist contracted and the fingers tightly flexed into a fist, without any device in place to prevent further contracture. When asked, the resident reported that staff had not come to encourage exercises for the arm and hand. The resident’s care plan indicated that the resident would engage in active range of motion (AROM) to all four extremities, but there was no evidence that this was being implemented for the contracted left hand. The restorative nurse stated that they were new, worked with the therapy department to determine needed services, and were not aware that the resident’s hand was contracted. The therapy manager also reported that no one had informed therapy of the contracture. Upon direct assessment, the therapy manager asked the resident to open the hand and stretch the wrist, which the resident attempted but reported pain. The therapy manager stated the resident would benefit from a left-hand resting splint. Facility policies and the restorative nurse job description require evaluation of newly admitted residents for restorative appropriateness, quarterly and with change of condition, coordination with therapy disciplines for rehabilitation plans of care, and supervision of rehabilitative/restorative equipment such as splints, but these processes were not carried out for this resident’s hand contracture.
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