Failure to Consistently Apply Physician-Ordered Hand Splints for Contractures
Penalty
Summary
The facility failed to implement physician-ordered bilateral palm protectors/hand orthoses for a resident with bilateral hand contractures. On multiple observations over several days, the resident was seen without any splints in place on either hand, and later with a splint only on the left hand while the right-hand splint was on the bedside table or not in use. The resident’s care plan documented an alteration in functional performance requiring assistance with self-care and included an intervention for bilateral palm protectors per order. An Occupational Therapy assessment identified impaired ROM in both upper extremities due to contractures, and the quarterly MDS documented severe impairment in daily decision making and impaired ROM in both upper extremities. A physician’s order directed that the resident was to have bilateral palm protectors or hand orthoses during the daytime, removed at night and for bathing, with no documentation on the MAR of any refusals to wear the devices. Despite this, surveyors repeatedly observed the resident without one or both splints in place. During interview, the Regional Nurse Consultant stated that floor nurses were responsible for ensuring the resident had bilateral splints in place. The facility’s assistive device and splint policy stated that nurses were responsible to monitor for consistent use of such devices, including orthotic equipment and splints, to maintain or improve function, dignity, and quality of life.
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