Failure to Monitor and Manage Constipation per Bowel Protocol
Penalty
Summary
The facility failed to monitor and manage constipation for a resident as required by physician orders and facility policy. The resident, who had diagnoses including Parkinson's disease, constipation, dementia, and other chronic conditions, reported experiencing hard bowel movements and periods of up to three days without a bowel movement. Despite a physician's order for a bisacodyl suppository as needed for constipation, there was no documentation that the bowel protocol or prescribed interventions were implemented during periods of constipation. Review of the resident's clinical record and bowel elimination logs revealed gaps in monitoring and documentation. The bowel elimination record showed multiple periods where the resident did not have a bowel movement for more than 72 hours, specifically between 3/16/25 to 3/18/25 and 3/24/25 to 3/31/25. Staff interviews confirmed that concerns about constipation were reported to nursing, but there was no evidence in the clinical record that the bowel protocol was followed or that interventions were provided during these times. The last documented use of the bowel protocol for this resident was in December 2024, despite ongoing issues. Facility policy required that bowel movements be documented every shift, that a bowel movement report be run nightly, and that residents with no bowel movement in 72 hours receive assessment and intervention. Interviews with staff, including CNAs, RNs, and the unit manager, confirmed that these procedures were not consistently followed for this resident. The lack of monitoring and failure to implement the bowel protocol as ordered resulted in the deficiency.