Failure to Prevent Severe Constipation and to Follow Physician Orders for Seizure Medication Monitoring
Penalty
Summary
The facility failed to provide appropriate treatment and care according to physician orders and resident needs in two key areas. For one dependent resident with a history of malignant neoplasm of the right breast, constipation, and chronic pain managed with daily narcotic medication, the facility did not effectively prevent the development of severe constipation. Despite being on a bowel regimen and having PRN medications available, the resident developed a large stool burden and was hospitalized with a diagnosis of Stercoral Colitis secondary to severe constipation. Staff interviews revealed that while the resident was known to be at risk for constipation and had a history of bowel concerns, there was a lack of effective monitoring, assessment, and documentation regarding bowel movements and the administration of PRN bowel medications. The Director of Nursing confirmed that interventions were not effective and that there was insufficient documentation of assessments or progress notes related to the resident's bowel status prior to hospitalization. Additionally, the facility failed to follow physician orders for monthly laboratory monitoring of seizure medication levels for two residents with seizure disorders. For one resident prescribed carbamazepine, monthly lab draws were ordered to ensure therapeutic levels, but there were missed months where no labs were drawn or documented, and no evidence that the physician was notified of the missed labs. The resident's medication level was found to be low on one occasion, and the nurse practitioner expected a follow-up lab, which was not completed. Similarly, another resident with orders for monthly levels of multiple seizure medications did not have documentation of these labs being completed or the physician being notified of missed tests. Facility policy requires that physician orders be followed as written, including appropriate contact or notification for labs or pharmacy needs. The lack of adherence to these orders and insufficient monitoring and documentation contributed to the deficiencies identified in the care of residents at risk for constipation and those requiring therapeutic drug monitoring for seizure management.