Failure to Provide Ostomy Care per Physician Orders and Professional Standards
Penalty
Summary
A deficiency occurred when a resident with an ileostomy did not receive ostomy care in accordance with physician's orders and accepted professional standards. The resident, who had diagnoses including morbid obesity, peripheral vascular disease, ileostomy, dementia, and cognitive deficit, required supervision or assistance with ostomy management. The resident reported that she often changed her own ostomy appliance due to staff being busy and had not received formal training from the nursing staff. She also stated that the facility frequently ran out of her prescribed nystatin powder, and that staff used different types of appliances and methods for her ostomy care, depending on what supplies were available. Direct observation revealed that a registered nurse performed ostomy care without reviewing the resident's treatment orders beforehand. The nurse failed to follow several critical steps, including not using dedicated clean scissors, not cleaning the scissors before use, not applying skin prep or nystatin powder as ordered, and not using wound cleanser to clean the stoma area. The nurse also did not change gloves between dirty and clean tasks and did not wash hands with soap and water after the procedure. The resident's skin around the stoma was observed to be red, inflamed, and painful, with stool leaking from beneath the appliance. Interviews with staff confirmed that nurses were expected to check physician's orders before treatments and use designated equipment for wound and ostomy care. Staff also indicated that residents should not perform their own wound or ostomy care without a safety assessment, and that proper hand hygiene and glove changes were required to prevent infection. The assistant director of nursing and other staff acknowledged that the resident insisted on changing her own appliance, but documentation of education provided to the resident was lacking. The facility's failure to ensure consistent, ordered, and hygienic ostomy care led to the deficiency.