Failure to Provide Timely Incontinence and Colostomy Care Resulting in Skin Excoriation
Penalty
Summary
A resident with a history of multiple complex medical conditions, including a colostomy, was observed to have significant issues with timely and appropriate care for activities of daily living, specifically related to incontinence and colostomy management. On observation, the resident was found in bed with a colostomy bag that was three-quarters full and leaking liquid stool onto the abdomen, perineal area, and buttocks. The skin in these areas was red and excoriated, and the resident expressed pain and discomfort. Despite the resident's call light being activated, there were delays in care, with a CNA initially attempting to clean the resident but unable to resolve the leakage, and an RN changing the colostomy bag but leaving the resident partially soiled. The resident remained soiled for over an hour until a hospice aide, not facility staff, completed the cleaning. Interviews and record reviews revealed that the resident was dependent on staff for toileting and daily care, had moderate cognitive impairment, and was at risk for skin complications due to incontinence. The care plan specified the need for skin care after each incontinence episode, and wound care notes documented existing incontinence-associated dermatitis. Family members reported ongoing concerns about the lack of timely care, including an incident where the resident's call light was not functioning and staff failed to check on the resident despite being informed of his condition. The facility's incontinence care policy required keeping residents dry and comfortable to prevent skin breakdown, but this was not followed in the resident's case. Documentation also included a grievance from the resident's family regarding neglect during the night, with findings that staff were educated on the resident's needs. Despite these interventions, observations and interviews confirmed that the resident continued to experience delays in care, resulting in prolonged exposure to feces and worsening skin excoriation. The failure to provide timely and adequate incontinence and colostomy care directly led to the resident's painful skin condition.