Failure to Implement Comprehensive Care Plan for Constipation Management
Penalty
Summary
The facility failed to implement a comprehensive, person-centered care plan for a resident with a known history of constipation, resulting in the resident being hospitalized for fecal impaction. The resident had a care plan in place identifying her risk for constipation related to polypharmacy, with goals and interventions such as following bowel management orders, administering Glycolax as needed, and monitoring for signs and symptoms of complications. Despite this, documentation revealed multiple instances where the resident went several consecutive days without a documented bowel movement, including a period of six days, without evidence of appropriate interventions or provider notification. The resident continued to receive Lomotil, an antidiarrheal medication, three times daily during these periods of no bowel movement, and the PRN laxative MiralAX was not administered. There was no documentation of nursing interventions, administration of constipation medications, or notification to the physician regarding the resident's lack of bowel movements prior to her hospitalization. Interviews with facility staff, including the DON and the physician, confirmed that the physician was not informed of the resident's condition and that standing orders for constipation management were not followed. The facility's policy required ongoing assessment and timely revision of care plans, as well as prompt intervention and communication when residents experienced changes in condition. However, staff failed to follow these protocols, resulting in a lack of action when the resident did not have bowel movements for several days. This failure to implement and update the care plan as required led to the resident's hospitalization for fecal impaction.