Failure to Obtain and Document Orders for Colostomy and Dialysis Care
Penalty
Summary
The facility failed to provide treatment and care in accordance with professional standards, the comprehensive care plan, and residents' preferences for three residents. One resident with a history of spina bifida, epilepsy, muscle weakness, and paraplegia was admitted with a colostomy, but there were no physician orders in place for managing or maintaining the colostomy since admission. The resident's care plan addressed bowel incontinence and skin integrity but did not include specific interventions for colostomy care, and the physician orders lacked any direction for colostomy management. Additionally, two residents with chronic kidney disease and other comorbidities required regular dialysis treatments. Although their care plans and assessments indicated the need for dialysis, there were no physician orders specifying the days on which dialysis was to be provided, despite both residents attending dialysis sessions on a set schedule. Interviews with facility staff, including the DON, RN, and ADON, confirmed that orders for colostomy care and dialysis schedules were expected but missing, and that the absence of such orders could result in missed care.