Failure to Provide Proper Ostomy and Tube Feeding Care
Penalty
Summary
A resident with complex medical needs, including acute and chronic respiratory failure, Rett's syndrome, seizure disorder, and dependence for all activities of daily living, did not receive proper care and assistance in managing his ostomy and tube feeding requirements. The resident was dependent on staff for all care, had a colostomy, a G-tube and J-tube, and required regular monitoring and maintenance of these devices as per physician orders and facility policy. Documentation and observation revealed that required care, such as changing the colostomy skin barrier appliance and bag when detached, applying prescribed ointments for skin irritation, and conducting weekly skin checks, was either not performed or not documented as completed. There was also a lack of evidence that staff monitored and reported changes in the resident's stoma site and peristomal skin as ordered. On one occasion, the resident was found by EMS covered in tube feeding formula and feces, with the ostomy bag detached and not replaced, and gastric contents leaking onto his skin, clothing, and bedding. The hospital emergency department documented that the resident arrived with an unattached ostomy bag, significant skin irritation, and evidence of medical neglect. The resident's abdominal area and perineal region were extremely red and irritated, and the hospital diagnosed candida dermatitis, irritant contact dermatitis, and leaking PEG tube. Facility staff failed to recognize, report, or treat the resident's skin breakdown and did not notify the nurse practitioner of the resident's condition. Further observations in the facility revealed the resident left alone in his room with a strong odor present, a large puddle of gastric contents on the floor, and his clothing and wheelchair saturated with drainage from a leaking tube. Staff interviews indicated confusion about who was responsible for the resident's care and a lack of awareness or follow-through regarding the resident's skin condition and tube management. Facility policy required competent nursing staff to provide routine ostomy and enteral tube care, including monitoring for signs of irritation and leakage, but these standards were not met for this resident.