Failure to Prevent and Manage Constipation Resulting in Fecal Impaction
Penalty
Summary
The facility failed to ensure that a resident was free from constipation and did not implement appropriate interventions to prevent constipation, as required by physician orders and the resident's care plan. The resident, who had multiple diagnoses including metabolic encephalopathy, coronary artery disease, heart failure, hypertension, peripheral vascular disease, thyroid disorder, and osteoporosis, was admitted and later discharged after experiencing a significant episode of constipation. The baseline care plan identified the resident as at risk for bowel and bladder issues, but there were no updates or specific interventions added to address constipation. Despite the facility's standing physician orders for constipation management, which included the use of Milk of Magnesia and notification of the physician if there was no bowel movement, the resident did not have any stool softeners or standing orders for constipation on the Medication Administration Record. Documentation showed that the resident did not have a bowel movement for five days, during which time therapy staff reported complaints of stomach pain and constipation to nursing staff. The physician was eventually notified and prescribed a stool softener, after which the resident had several small and large bowel movements, but no further bowel assessments were completed. Subsequently, the resident experienced increased respiratory rate, low oxygen saturation, and was sent to the hospital, where a rectal fecal impaction and colitis were diagnosed. Interviews with facility leadership and the medical director confirmed that there was a lack of ongoing bowel assessments after the initial intervention, and that the only bowel protocol in place was for Milk of Magnesia, which was not administered prior to physician notification. The medical director also indicated that she was not fully informed of the duration of the resident's constipation and expected more thorough nursing assessments during the period in question.