F0688

D

Failure to Implement Ordered Hand Splint and Arm Trough for Resident With Hemiplegia

Prospect Heights, Illinois Survey Completed on 12-12-2025

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to follow physician orders and implement care plan interventions for a resident with limited mobility and hemiplegia affecting the left dominant side. During observation, the resident was seen in a Broda recliner in the activity room leaning to the right side without the ordered left hand splint or wheelchair arm trough in place. After this was shown to the DON, the resident was repositioned upright, but staff confirmed that the left hand splint and wheelchair resting arm were not applied. The resident’s active physician orders required application of a functional hand splint to the left hand, removable only for hygiene, skin checks, and as tolerated, and use of a wheelchair arm trough on the left side while up in the wheelchair on day and evening shifts.

The comprehensive care plan documented that the resident had ADL self-care performance deficits related to impaired mobility, generalized weakness, and hemiplegia, with interventions including an AFO on the left lower extremity while up, a left upper extremity sling and hand splint while up and during transfers, and elevation of the left arm in a trough with skin observations during AM/PM care. The MDS assessment showed impairment in functional ROM on one side for both upper and lower extremities, and the OT discharge summary recommended assistance with all ADLs and functional transfers, a left arm trough, and a left resting hand splint to prevent contractures due to limited mobility. The Administrator and DON reported that the facility did not have a restorative program or a policy to prevent contractures for residents with limited mobility, despite existing policies on orthotics, physician orders, and care planning that outlined requirements for orthotic use and implementation of provider orders.