Failure to Initiate Restorative Nursing Program After Therapy Referral
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate restorative nursing services to maintain or improve range of motion (ROM) for a resident who had significant mobility impairments. The resident was admitted with paralysis from the neck down, contractures of the left hand, and stiffness of the left hip, both knees, and both ankles. An Occupational Therapy (OT) discharge summary documented that the resident should be referred to the Restorative Nursing Program (RNP) for passive ROM to both arms and legs three times per week, and for application and removal of a right-hand splint and a left-hand palm protector by a restorative nursing assistant. Review of the resident’s medical record showed no documentation of any RNP activities, and the Medical Records Assistant confirmed there was no order for the recommended RNP or evidence that RNP services had been initiated. Interviews with facility staff confirmed that the RNP referral and order process was not completed. The Director of Rehabilitation acknowledged that the RNP referral/order for the resident was not completed and described a new process in which she would initiate the RNP order and the Director of Nursing (DON) would confirm and obtain the physician’s order. The DON stated she expected the Rehabilitation Department to write the RNP order, and Nursing to confirm the order, create the plan of care, and add RNP tasks into the electronic medical record. Licensed nurses interviewed stated that there should be an order in place if a resident is to be on RNP, but one was not present. Review of the facility’s Restorative Nursing Program policy showed that it assigned responsibility to Nursing for initiating and updating the RNP plan of care but did not specify how an RNP order is generated from a Rehabilitation referral or clearly define the roles of Rehabilitation and Nursing in initiating RNP services, contributing to the failure to implement the ordered restorative care for this resident.
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