Failure to Follow Physician Orders for ROM Devices and Splinting
Penalty
Summary
The deficiency involves the facility’s failure to follow physician orders for range of motion (ROM) and positioning devices for two residents with significant functional limitations. One resident, initially admitted with respiratory failure and documented functional limitations in ROM of both upper and lower extremities, had physician orders for a left and right towel roll in each hand every day shift. On observation, this resident was in bed with upper extremities flexed on the chest and no hand rolls in either hand. During interview, the Restorative Nursing Assistant (RNA) confirmed the resident was supposed to have towel rolls in each hand and stated she had given the resident a shower that morning and forgot to replace the towel rolls, acknowledging she was responsible for placing them. The second resident, also admitted with respiratory failure and documented functional limitations in ROM of all extremities, had a physician order for nursing/RNA to manage a left elbow extension splint up to four hours as tolerated each day shift. On observation, this resident was in bed with the left upper extremity extended at the side and no elbow splint in place. During interview, the RNA stated she was not aware the resident had a left elbow splint and reported that all splints were kept in a mesh bag, but there was no elbow splint present. Review of the facility’s Restorative Nursing Assistant Program policy indicated the facility is responsible for providing maintenance and restorative programs and that the RNA carries out programs according to the written plan of care, including splinting and application of orthotics and braces.
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