Failure to Provide Timely Pain Management and Colostomy Care
Penalty
Summary
The facility failed to identify and provide appropriate pain management for a resident with significant excoriation and discomfort around a colostomy site. Observations revealed that the resident was left in bed with a leaking colostomy bag, resulting in liquid stool covering the abdomen, perineal area, and buttocks, causing visible redness and excoriation. The resident expressed pain and discomfort, stating that it hurt and burned, and was visibly shaking and apprehensive during care. Despite these clear signs of pain, staff did not promptly clean the resident or apply prescribed creams, and the resident remained soiled for an extended period until a hospice aide intervened. Record review showed that the resident had multiple complex medical diagnoses, including Autism and moderate cognitive impairment, which may have affected pain communication. The care plan documented an alteration in comfort and included general pain assessment interventions but lacked specific strategies for managing pain related to excoriation or tailored approaches for the resident's cognitive and developmental needs. There was no documentation of pain assessment since several weeks prior, and prescribed topical treatments for excoriation had not been administered as ordered. Interviews with staff and the resident's family confirmed that the resident was not being kept clean, colostomy care was inadequate, and pain management interventions were not consistently implemented. The facility's pain management policy required regular pain assessments and individualized care planning, but these were not followed, resulting in ongoing pain and discomfort for the resident.