Unauthorized Application of Nair to Perineal Area Resulting in Chemical Burn
Penalty
Summary
The deficiency involves a CNA applying Nair, a chemical hair removal cream, to a resident’s perineal area without a physician’s order, resulting in a chemical skin burn. The CNA reported that the cream was present in the resident’s room and that the resident requested its use during a shower. The product was applied as a personal hygiene measure despite facility expectations, as described by multiple LPNs and the unit manager, that any over-the-counter product such as Nair requires a physician’s order and must be stored securely. The CNA’s actions occurred outside the scope of delegated tasks, as other staff indicated that chemical hygiene products should be applied by a nurse and that cognitively impaired residents are not reliable sources for requesting such products without an order. The resident involved had multiple significant medical diagnoses, including multiple sclerosis, cerebrovascular disease with hemiplegia and hemiparesis, DVT, and epilepsy, and was identified as a long-term resident requiring extensive assistance with care. A recent BIMS score of 5 indicated severely impaired cognition, and she was dependent on staff for all care, including the ability to remove products such as Nair from her skin. Following the application of the cream, an LPN performing a regular wound treatment the next day observed that the resident’s peri area was red and sore. The LPN initially thought the area resembled razor burn and then confirmed with the CNA that the area had not been shaved but had been treated with Nair at the resident’s request. Subsequent documentation and hospital records described the resident’s peri area as pink and appearing healed on a weekly skin assessment, but the hospital later reported that she had chemical burns on her bilateral thighs and labia due to Nair being left on too long, and that she developed cellulitis from the burn. The resident’s mother, who was her legal guardian, stated she had purchased the Nair for use on the resident’s legs and that family members had applied it to the legs, not the peri area. She learned from facility staff that the cream had been applied to the peri area by staff and that this resulted in a chemical burn. The resident herself reported not knowing what Nair was, did not know who applied it to her peri area, and stated that the staff member who applied it did not provide additional care that day. The facility’s policies and staff interviews confirmed that over-the-counter products like Nair required a physician’s order, secure storage, and appropriate delegation, which did not occur in this incident, leading to the resident receiving treatment without an order and sustaining a chemical burn.
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