Failure to Provide Appropriate Bowel Incontinence Care and Restore Normal Function
Penalty
Summary
A resident with a recent above-the-knee amputation, multiple comorbidities including diabetes, malnutrition, chronic osteomyelitis, and a stage 3 sacral pressure ulcer, was admitted to the facility and began experiencing bowel incontinence after starting antibiotic therapy. The resident reported that he had not been incontinent of bowel prior to the antibiotics and attributed the new onset of incontinence to the medication. Despite this, staff placed the resident in briefs as a preventive measure and instructed him to use the brief instead of a bed pan, which led to soiling of his wound vacuum dressing and increased pain during dressing changes. Record review showed that the resident was receiving both antibiotics and a stool softener (senna-docusate sodium) even as he developed frequent episodes of diarrhea and bowel incontinence. Documentation indicated that the resident was sometimes continent and sometimes incontinent, with several episodes of diarrhea noted. Staff interviews revealed that the LPNs were aware of the resident's incontinence and the ongoing administration of stool softeners despite the presence of diarrhea. The nurse manager acknowledged that stool softeners should be held if a resident is experiencing loose stools, but this was not done in a timely manner. The care plan addressed the potential for adverse effects from antibiotics, including diarrhea, and called for monitoring and intervention. However, staff did not promptly adjust the resident's bowel regimen or consistently use interventions to restore normal bowel function, such as offering a bed pan as requested by the resident. The facility also failed to provide a policy on bowel incontinence when requested by surveyors.