Resident Left on Bedpan for Extended Period Without Hygiene Care
Penalty
Summary
A resident with a history of traumatic subdural hemorrhage, repeated falls, and Parkinson's Disease was left on a bedpan for four hours during the night shift. The resident reported significant discomfort, including pain in the bottom, legs, and heels, and was not cleaned after being removed from the bedpan. The resident had to wait until the day shift for proper hygiene care, at which time dried feces and a ring from the bedpan were observed on the skin. The resident communicated the incident to the Social Worker the following day. Interviews with staff confirmed the resident's account, with the day shift CNA noting the resident's distress and the physical evidence of prolonged bedpan use. The DON stated that residents should be checked within five minutes of being placed on a bedpan and always cleaned afterward. Facility records and staff interviews indicated that the expected standard of care was not met, resulting in neglect as defined by facility policy.