A resident with stroke-related R-sided hemiparesis and a hand contracture was ordered to wear a resting hand splint on the R hand at all times except for hand washing and skin checks. Surveyors observed the resident multiple times without the splint, and the device was found stored in the room rather than in use. The resident said he did not think he had worn it for some time, CNA staff said they usually applied it but did not document it, and the EMAR/progress notes lacked documentation of application or refusal.
Two residents with neurological impairments and contractures did not consistently receive prescribed cervical collars and a mechanical back/cervical splint during bedrest and meals. One resident, ordered to wear a soft cervical collar in bed and for all meals for neck contracture management, was repeatedly observed without the collar, which was found on the bedside stand, and her care plan and CNA Kardex lacked instructions for its use or refusal despite documentation that she preferred wearing it. Staff gave conflicting accounts about whether the collar was still in use, and there was no documentation of refusals as required by facility policy. Another resident, ordered to wear a cervical brace during all meals, was repeatedly observed with her head leaning to one side, without the brace, and not eating, while CNAs reported the brace’s Velcro failed and her head slipped out despite repeated attempts to reposition and reapply it. Therapy and restorative staff acknowledged ongoing issues with the brace, missed reassessment, and lack of reported concerns, contrary to facility policy requiring regular assessment and reporting of problems with assistive devices.
A resident with a history of stroke, severe protein malnutrition, seizures, pressure ulcer, and a documented right lower extremity contracture was admitted with limited ROM in both legs and was dependent for ADLs. PT was ordered to address decreased strength, impaired balance, and functional mobility, including a goal for use of a knee orthotic to inhibit abnormal positioning. However, the initial PT evaluation did not document lower extremity strength, degree of contracture, or specific functional limitations, and subsequent PT notes showed only assisted ROM and gentle stretching, with the resident unable to perform ROM independently. The right knee orthotic was briefly trialed but removed after short periods due to pain, and there was no further documented use or clinical rationale for discontinuation, despite recertified plans that continued to reference possible orthotic management. Staff interviews confirmed lack of clear documentation regarding the orthotic’s ordering, fitting, and discontinuation, and the restorative nurse reported the right knee contracture remained unchanged at the time of review.
A resident with traumatic brain injury, dementia, and bilateral upper extremity contractures had physician orders and a care plan for daytime use of bilateral palm protectors/hand orthoses, but surveyors repeatedly observed the resident without one or both splints in place. The MAR showed no refusals, and the resident was documented as severely impaired in decision making and needing assistance with self-care. Despite a facility policy assigning nurses responsibility for consistent use and monitoring of orthotic devices, staff did not ensure both hand splints were consistently applied as ordered.
A resident with severe cognitive impairment and multiple mobility-limiting diagnoses was observed with wrist contractures and reported limited hand use. Although the care plan required daily ROM exercises, there was no documentation in the MAR, TAR, or aide task sheets that these were provided. The DON confirmed ROM was not documented or tracked due to the lack of a restorative program and policy.
A resident with quadriplegia and impaired mobility did not have hand or elbow splints applied as ordered by the physician, despite documentation by nursing staff and CNAs indicating otherwise. Observations over several days confirmed the splints were not in use, and staff interviews revealed that documentation reflected PROM exercises rather than actual splint application.
Two residents with limited ROM did not have physician-ordered anti-contracture devices in place as required. One resident with a left hand contracture was repeatedly observed without a palm protector or rolled wash cloth, despite orders and documentation indicating otherwise. Another resident with a contracted hand had no care plan or documentation of the ordered hand guard being applied or refused, and staff confirmed there was no system to record refusals or alternative interventions.
A resident with left-sided hemiplegia and limited ROM did not receive a prescribed hand splint or range of motion exercises as outlined in the care plan. Despite the resident's request and documented need, the splint order was not processed, and staff did not perform ROM interventions. The facility lacked restorative aides and did not implement a restorative program for the resident, resulting in a failure to provide necessary services to prevent further decline.
A resident with bilateral hand contractures, severe cognitive impairment, and multiple medical diagnoses was observed multiple times without any splints or supportive devices in place, despite the care plan identifying risk and the facility's policy requiring such interventions. The responsible RN confirmed that no splints or carrots had been used since admission.
A resident with a history of Alzheimer's, stroke, and right side hemiplegia was repeatedly observed in a wheelchair without the required right shoulder arm tray, despite physician orders and care plan directives for its use to support the upper extremity. Staff interviews confirmed the tray was not consistently in place, and there was no documentation of refusals.
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