Failure to Develop Comprehensive Care Plan for Colostomy Self-Management
Penalty
Summary
The facility failed to develop a comprehensive care plan that addressed a resident's self-management of his colostomy bag. The resident, who had diagnoses including osteomyelitis, functional quadriplegia, and dependence on renal dialysis, was cognitively intact and had an ostomy. Despite these conditions, the care plan did not include measurable objectives or interventions related to the resident's behavior of emptying his own colostomy bag, nor did it address the associated infection control concerns. Observations and interviews revealed that the resident regularly emptied his colostomy bag himself, using a white trash bag and discarding it on the floor, which sometimes resulted in fecal matter splattering on the floor. Staff, including LVNs, CNAs, the ADON, and the DON, were aware of this behavior and acknowledged it as an infection control issue. The behavior was discussed in morning meetings, and some interventions, such as providing a tall trash can, were implemented informally, but these actions were not documented in the resident's care plan. Record reviews confirmed that the care plan focused on other aspects of the resident's care, such as gastrointestinal status and ADL deficits, but did not address the specific issue of self-emptying the colostomy bag. Staff interviews indicated that the MDS coordinator was responsible for care plans but may not have been aware of the resident's behavior, and the lack of documentation in the care plan led to a gap in individualized care planning for this resident.