Failure to Provide Timely Assessment and Treatment for Constipation, Bruising, and Edema
Penalty
Summary
The facility failed to provide appropriate treatment and care according to physician orders and resident needs in several instances. One resident with a history of acute respiratory failure, heart disease, and severe cognitive impairment was at risk for constipation and had physician orders for bowel management, including a PRN bisacodyl suppository. Despite multiple documented periods of no bowel movement, the PRN suppository was not administered, and there was no facility policy for constipation management. The Director of Nursing confirmed that staff should administer PRN medications after three days without a bowel movement or contact the physician if no PRN orders were available. Another resident on anticoagulant therapy with a history of heart failure and diabetes was observed with bruising on the shins and right knee over several days. The care plan required monitoring and documentation of bruising, and physician orders directed staff to observe for signs of bleeding every shift. However, the record lacked documentation of assessments for the bruised areas. Additionally, a resident with chronic kidney disease and heart disease was observed with persistent hand swelling and pitting edema, but the record contained only one assessment and lacked care plan interventions for edema monitoring or treatment. Nursing staff were unaware of the swelling, and the DON acknowledged that regular assessment and documentation were required but not completed.