Failure to Ensure Timely Follow-Up for Constipation Management
Penalty
Summary
A deficiency was identified when a resident with a history of constipation, diabetes mellitus type 2, and end stage renal disease did not receive timely follow-up for constipation despite not having a bowel movement for multiple days. The resident was cognitively intact and had a care plan in place that included monitoring bowel movements every shift, administering medications as ordered, and reporting signs and symptoms of complications related to constipation. The resident was prescribed both scheduled and PRN medications for constipation, and was also receiving opioid pain medications, which can contribute to constipation. Record review showed several periods where the resident went multiple days without a documented bowel movement, specifically from 4/4 to 4/9, 4/13 to 4/17, and 4/19 to 4/22. During these periods, PRN medications were not consistently administered according to the facility's stated practice of intervening after three days without a bowel movement. For example, on some days when the resident had not had a bowel movement for several days, no PRN medication was given, and the resident reported not having a bowel movement in about a week. Staff interviews revealed inconsistent understanding and application of the bowel management protocol, with some staff stating that action should be taken after three days, while the DON confirmed there was no formal bowel protocol in place. The facility lacked a written policy or protocol for bowel management, and staff responses indicated variability in how constipation was addressed. The absence of a standardized approach led to delays in intervention and inconsistent administration of PRN medications, resulting in the resident experiencing prolonged periods without a bowel movement despite being at risk due to medical history and medication regimen.