Failure to Ensure Competent Ostomy Care by Nursing Staff
Penalty
Summary
The facility failed to ensure that nursing staff possessed the necessary competencies and skills to provide care in accordance with the resident's care plan and individual needs, specifically in the case of one resident with a colostomy. The resident, who had a history of colostomy status, diverticulitis with perforation, and chronic pain, required regular colostomy care as outlined in both physician orders and the care plan. The facility's policy for ostomy care included specific steps to maintain cleanliness, skin integrity, and infection prevention, as well as proper documentation and use of appropriate supplies. On one occasion, an agency LPN removed the resident's colostomy bag, discarded it, and was unable to find a replacement that fit from the supplies available in the resident's room. Instead of seeking assistance or obtaining the correct supplies from the supply room, the LPN retrieved the soiled bag from the garbage, cleaned the outside with bleach and the inside with mouthwash, and reapplied it to the resident's stoma. The LPN did not consult the RN supervisor on duty and relied on previous experience as a nurse aide for this method, which was not in accordance with facility policy or standard practice. The nurse aide on duty also indicated a lack of competency in emptying a colostomy bag and did not assist with the care. Interviews with other LPNs confirmed that proper procedure involves gathering new supplies before entering the room and that nurses, not nurse aides, are responsible for ostomy care. The Director of Nursing acknowledged that the LPN did not follow standards of practice for colostomy care. The incident demonstrated a failure to ensure that staff were competent and followed established procedures for ostomy care, as required by facility policy and resident care plans.