Failure to Provide Timely and Appropriate Colostomy Care Resulting in Skin Excoriation
Penalty
Summary
The facility failed to provide appropriate colostomy care for a resident who required such services, resulting in the resident developing painful, red excoriation around the colostomy site, extending to the abdomen and perineal area. Direct observation revealed that the resident's colostomy bag was three-quarters full and leaking liquid stool onto the skin, which was left unaddressed for an extended period. The resident was visibly in pain, expressing discomfort and apprehension during care attempts, and was not promptly or thoroughly cleaned by staff, leaving feces on the skin for over an hour until a hospice aide intervened. Documentation and interviews indicated that the resident had multiple complex medical diagnoses, including autism, chronic kidney disease, and a history of abdominal surgery resulting in a colostomy. The care plan identified the resident as dependent on staff for daily care and at risk for skin complications related to stoma incontinence-associated dermatitis. Despite this, there were no specific physician orders for colostomy care or frequency of bag changes, and the treatment administration record showed that prescribed creams for skin protection were not consistently applied as ordered. Staff interviews revealed inconsistent understanding and implementation of colostomy care, with some staff attributing leaks to the resident's behavior and others acknowledging the need for frequent checks and cleaning. The facility's policy required colostomy/ileostomy bags to be changed at least every five days and as needed, with documentation of care and skin condition. However, there was no documentation of colostomy care or bag changes on the treatment administration record, and the resident's family reported that staff were not changing the colostomy bag or cleaning the resident adequately, particularly during night shifts. The lack of timely and appropriate colostomy care directly led to the resident's skin breakdown and ongoing discomfort.