Failure to Identify and Respond to Constipation Leading to Hospitalization
Penalty
Summary
The facility failed to identify and respond to a clinically relevant pattern of constipation for a resident, resulting in hospitalization for fecal impaction. The resident, who had a history of constipation and alternating diarrhea, experienced multiple days without a documented bowel movement in January. Despite standing orders for constipation management and alerts in the facility's system for three consecutive days without a bowel movement, there was no documentation of nursing interventions, administration of constipation medications, or physician notification during these periods. The resident continued to receive Lomotil, an antidiarrheal medication, even as the lack of bowel movements persisted, and a PRN order for MiralAX was not utilized. Interviews with staff revealed that CNAs were expected to notify nurses of bowel movement issues, and nurses were to follow standing orders and notify the physician if interventions were ineffective. However, the DON was unaware of the resident's ongoing constipation, and the physician was not informed of the absence of bowel movements for six consecutive days prior to hospitalization. The facility did not have a specific policy for constipation or bowel movements, and documentation failed to reflect any assessment or intervention for the resident's constipation prior to the acute hospital admission for fecal impaction.