Failure to Inform Resident Prior to Application of Barrier Cream
Penalty
Summary
A deficiency occurred when a resident, who was cognitively intact and had recently been admitted following a pacemaker placement, was not fully informed prior to the application of barrier cream to the perineal area. The resident required partial to moderate assistance with toileting and was at risk for skin problems, but there was no physician order for barrier cream documented in the resident's records. On the day of the incident, a CNA who was not regularly assigned to the resident responded to a call light and, upon noticing reddened skin and the presence of barrier cream in the bathroom, applied the cream without adequately informing the resident of the intended care. The resident reported feeling violated by the application, stating that no care staff had previously used barrier cream on them and that the CNA did not answer when asked about the reason for its use. The resident experienced a burning sensation from the cream and required assistance from a nurse to remove it. Multiple staff interviews confirmed that the resident was not appropriately informed prior to the application, and that informing residents of care is an expected protocol and a resident right. The CNA involved stated that they believed they had informed the resident, but other staff and the DON acknowledged that the explanation was insufficient. Facility policy requires that residents be informed of all aspects of their care, including participation in planning and any changes in treatment. Staff interviews consistently indicated that all residents should be informed of care prior to its delivery, and that this expectation was not met in this instance. The lack of clear communication and failure to obtain informed consent for the application of barrier cream led to the resident's distress and the subsequent deficiency finding.