Failure to Monitor and Intervene for Constipation Leading to Fatal Fecal Impaction
Penalty
Summary
A facility failed to ensure that a resident with a known history of constipation received necessary treatment and care in accordance with facility policies, procedures, and professional standards of practice. The resident, who was cognitively intact and dependent on staff for activities of daily living, repeatedly refused continence care and brief changes over several days. Despite these refusals and the resident's infrequent bowel movements, nursing staff did not adequately monitor or document bowel movements, assess for abdominal distention, or notify the physician in a timely manner about the ongoing refusals and lack of bowel movements. The facility also did not implement a bowel protocol or alternative interventions to prevent complications from constipation and impaction. Multiple staff interviews revealed that neither licensed nurses nor CNAs could confirm whether the resident had regular bowel movements, as the resident often refused care and staff did not perform or document necessary assessments. Although the resident was on a PRN stool softener, it was not administered because staff could not confirm the need due to lack of documentation and assessment. The physician was reportedly informed verbally of the refusals but did not provide new orders, and there was no documentation of these communications or of any interdisciplinary team meetings or care conferences to address the ongoing refusals and risks. The facility's own policy required detailed documentation and physician notification in cases of treatment refusal, but these steps were not consistently followed. As a result of these failures, the resident developed a severe fecal impaction, presenting with altered mental status and hypotension, and was transferred to an acute care hospital. There, a large amount of hardened stool was removed, but the resident deteriorated rapidly, developed septic shock, and died later that day. The deficiency was directly linked to the lack of monitoring, assessment, documentation, and timely intervention in response to the resident's ongoing refusals and known risk factors for constipation and impaction.