Failure to Notify Physician of Prolonged Constipation Leading to Hospitalization
Penalty
Summary
The facility failed to notify the physician of a resident who had no documented bowel movement for six consecutive days, resulting in the resident being hospitalized for evaluation and diagnosed with fecal impaction. Despite the facility's policy requiring nursing staff to notify the physician of significant changes in a resident's condition, there was no documentation of nursing interventions, administration of constipation medications, or provider notification regarding the resident's ongoing constipation prior to hospitalization. Interviews with staff confirmed that while CNAs are expected to alert nurses after three days without a bowel movement and the EHR system provides alerts, the physician was not notified unless medications were ineffective. However, in this case, no medications for constipation were administered, and the physician was not informed of the resident's condition. The resident had a history of constipation and diarrhea, with a diagnosis of constipation and was receiving antidiarrheal medication (Lomotil) despite multiple days without a bowel movement. The medical record and MAR showed no documentation of interventions or physician notification during the periods of constipation, and the resident continued to receive Lomotil without any PRN laxatives being administered. The facility also lacked a specific policy regarding constipation or bowel movements, and the DON confirmed unawareness of the resident's lack of bowel movements prior to hospitalization.