Failure to Prevent and Monitor Fecal Impaction in Dependent Resident
Penalty
Summary
The facility failed to prevent a dependent resident from developing a large stool ball, resulting in hospitalization for fecal impaction. The resident had multiple diagnoses, including respiratory failure, tracheostomy status, anemia, seizures, hemiplegia, metabolic encephalopathy, and aphasia, and was identified as severely cognitively impaired and dependent on staff for all care. The resident was also frequently incontinent of bowels. Hospital records indicated the presence of a large stool ball in the rectum with mass effect on the bladder, requiring an enema. Facility staff noted changes in the resident's condition, including copious drainage from a sacral wound, increased pitting edema, decreased alertness, and lack of usual responsiveness. Interviews with facility staff revealed that symptoms of impaction, such as decreased bowel movements, discomfort, pressure, or bloating, were not effectively assessed or documented for this resident, who was unable to communicate. The care plan included monitoring and documenting signs of constipation or fecal impaction, but there was no evidence that this was consistently done. The nurse practitioner confirmed that the facility would not have known about the impaction unless daily tracking of bowel movements was performed, which was not documented in this case.