Failure to Provide Timely Ileostomy Care
Penalty
Summary
A deficiency occurred when a resident requiring ileostomy care did not receive services consistent with professional standards of practice. The facility's policy required ileostomy appliance changes every Tuesday and Thursday, and as needed for dislodgement, with documentation of care provided. The resident, who had diagnoses including Type 2 Diabetes Mellitus, moderate protein-calorie malnutrition, gastrostomy and ileostomy status, and dementia, was dependent on staff for personal hygiene and toileting. The care plan and medication administration record specified frequent attention to the ileostomy, including burping or emptying the appliance up to six times daily as needed. Despite these requirements, the resident was observed with loose feces on her skin due to leakage from the ileostomy bag, and a towel had been placed around the appliance to catch the feces. The resident's responsible party reported multiple complaints to the DON about the resident being left with feces on her and waiting long periods for ileostomy care. On the day of observation, a CNA reported the need for an appliance change to the treatment nurse, who indicated a delay. The treatment nurse did not provide care, and the LPN who eventually changed the appliance did so several hours later, after being informed late. Interviews confirmed a lack of timely communication and response among staff, resulting in the resident not receiving prompt and appropriate ileostomy care.