Failure to Ensure Physician Oversight of Wound Care for Resident with Colostomy
Penalty
Summary
The facility failed to ensure that a physician adequately supervised a resident's medical care and evaluated the effectiveness of wound care treatments for a resident with a colostomy and multiple chronic conditions, including atrial fibrillation and malnutrition. Upon admission, the resident had an abdominal ostomy site with surrounding erythema and skin breakdown. Care plans were in place to protect the skin from ostomy drainage, but physician documentation did not address the leaking ostomy or the condition of the surrounding skin. Progress notes over several days described persistent leakage, red and inflamed skin, and worsening excoriation, with staff frequently reporting the issue and providing wound care, but without effective resolution or physician intervention regarding the skin condition. The resident's condition deteriorated, resulting in extensive skin breakdown, maceration, and severe pain, ultimately requiring hospital transfer for evaluation and treatment. Hospital records confirmed significant skin damage related to ostomy leakage. Upon readmission, physician notes continued to omit assessment of the skin surrounding the colostomy site. Interviews with staff confirmed ongoing issues with the colostomy bag and skin integrity, and the physician acknowledged focusing on other medical concerns and not assessing the abdominal wound. The lack of physician oversight and failure to address the persistent skin issues led to the deficiency.