Failure to Ensure and Document Nurse Aide Competency for Abdominal Fistula Care
Penalty
Summary
The deficiency involves the facility’s failure to ensure that nurse aides demonstrated competency in the skills and techniques necessary to provide ordered abdominal fistula care for a resident. The resident had diagnoses including respiratory failure and hypertension and was admitted with an abdominal fistula covered with a colostomy bag. The physician’s order directed specific abdominal fistula care, including cleansing the abdominal area and fistula site, applying zinc oxide mixed with A&D ointment over the abdomen and around the fistula, placing a pantie liner or exu-dry over the fistula, then applying and securing a brief while ensuring the rough tabs did not touch the skin, and changing the dressing as needed or when soiled. The order also specified that aides were allowed to check and change the fistula care once they had been shown how to apply it, and that this care was to be provided every shift. According to the DON, the wound nurse (Employee 1) provided verbal training to nurse aides on how to perform the abdominal fistula care because this was not a type of care they were used to, and nurse aides were initially fearful of completing the order. The DON stated that nurse aides sometimes perform tasks outside their scope of practice and that some aides had reported feeling uncomfortable performing the abdominal fistula care for this resident; in such cases, the DON indicated a nurse would accompany them and that no one would be forced to perform the care if they were uncomfortable. Employee 1 reported that she provided both verbal education and hands-on training to nurse aides on the abdominal fistula care but had no documentation of this training or of which aides received it. The facility was unable to provide a list of nurse aides who completed the training or any documentation indicating that education and training on the abdominal fistula care had been completed, leading to the determination that the facility failed to ensure nurse aide competency as required by 483.35(d).
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