Failure to Apply Ordered Splints and Braces for Residents With Contractures
Penalty
Summary
The deficiency involves the facility’s failure to ensure that ordered splints and braces were applied for residents with contractures and limited range of motion. One resident with a history of stroke, hemiplegia affecting the right dominant side, major depressive disorder, hypertensive heart disease without heart failure, and osteoarthritis was observed on multiple occasions without the prescribed right-hand splint and right ankle orthosis in place. On one morning observation, the resident was lying in bed with a right-hand contracture and no splint on, and later the same day was again observed without the right-hand splint or right ankle orthosis. The LPN present acknowledged that both devices should have been on and stated they were used to prevent the resident’s contractures from worsening. The restorative nurse confirmed that the resident was on a ROM exercise program and splint program for the right upper extremity and right ankle orthosis, that the restorative aide was responsible for applying them, and that failure to apply them created the potential for further contracture. The care plan specified that the right-hand resting splint was to be worn for 6–8 hours with a defined on/off schedule, and the DON stated the expectation that staff carry out orders as prescribed, confirming the splint and orthosis should have been applied. A second resident with anoxic brain damage and gait and mobility abnormalities was also found without ordered hand splints. This resident was observed in bed without hand splints on both hands and was unable to fully open either hand. A subsequent observation the same day again found the resident without the bilateral hand splints. The LPN stated that restorative aides were responsible for applying the splints, and the restorative nurse stated that the resident should have splints on both hands to prevent further development of contractures. The physician order required resting hand splints to bilateral hands daily after morning care for six hours as tolerated, and the care plan indicated the resident would benefit from splints/braces due to actual contracture and limited ROM. Documentation survey reports for October and November showed that the resting hand splints were not being applied daily and did not document any refusals by the resident. The facility’s policy on application of splints required proper application per physician order and documentation of use, but this was not consistently carried out for this resident.
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