Failure to Obtain Colostomy Care Orders
Penalty
Summary
The facility failed to obtain physician orders for the care and management of a colostomy for one resident, identified as Resident R367. This deficiency was identified through a review of facility policy, clinical records, and interviews with the resident and staff. The facility's policy on colostomy care, dated 10/1/24, aims to prevent exposure of the resident's skin to fecal matter. However, upon review of Resident R367's clinical records, it was found that there were no physician orders for the colostomy care and management, which is inconsistent with professional standards of practice. Resident R367 was admitted to the facility with diagnoses including neurogenic bladder, paraplegia, and depression. The resident's care plan noted the presence of a colostomy for bowel diversion, with the goal of maintaining skin integrity. During an observation and interview, the resident confirmed having a colostomy. The Unit Manager RN and the Director of Nursing both confirmed the absence of necessary physician orders for the colostomy care, which constitutes a failure to meet the regulatory requirement for providing care consistent with professional standards and the resident's care plan.
Plan Of Correction
1. Physician orders were obtained for care of ostomy for R367. Plan of care was updated to reflect physician orders. 2. Director of nursing or designee will conduct a house audit of residents with ostomies to ensure orders are present and reflected in the plan of care. 3. Director of nursing or designee will in-service licensed nurses on ensuring physician orders for ostomy care are obtained on admission and reflected in the plan of care. 4. Director of nursing or designee will audit 2 residents with ostomies weekly for 3 weeks to ensure physician orders and care plan are present. Audit findings will be shared with QAPI committee.