Failure to Apply Prescribed Hand Splint for Contracture Management
Penalty
Summary
The deficiency involves the facility’s failure to apply a prescribed resting hand orthosis to a resident’s right hand for contracture management as ordered. The resident was admitted with a history of stroke with right-sided hemiparesis/hemiplegia and had severe cognitive impairment, with documented functional limitations in range of motion on one side of both upper and lower extremities. The care plan, initiated and later reviewed, included interventions such as performing ROM exercises with morning and evening care, applying the resting hand orthosis daily, and completing hand hygiene and skin checks. An OT discharge summary documented that the resident had reached maximum potential, that an order for the orthosis was in place, and that both family and nursing staff had been educated on splinting. A physician’s order directed that the right upper extremity splint be applied daily on day shift with hand hygiene and skin checks to prevent contracture and skin breakdown. On multiple observations over two consecutive days, the resident was seen in bed without the splint in place, while the splint was observed lying on the table in the room. Despite this, the TAR showed that the splint was documented as in place on those days by a nurse. In interview, the nurse stated that therapy staff had been placing the splint and then notifying her, and she would document it as applied, and she believed the splint was to remain in place for 8 hours, but she did not manage its placement or removal. The Rehabilitation Manager clarified that once the resident was discharged from therapy, nursing was responsible for managing the splint per the physician’s order, and that the recommended wear time was up to 4 hours during the day shift. The DON and Administrator both stated that the nurse on duty for those days was responsible for ensuring the splint was applied as ordered.
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