Failure to Initiate Bowel Management Protocol for Multiple Residents
Penalty
Summary
The facility failed to initiate bowel management interventions as outlined in its bowel protocol for six of seven sampled residents. According to the facility's policy, licensed nurses are required to identify residents who have not had a bowel movement for three days, review their medication administration records, and initiate a stepwise bowel protocol involving medications and assessments. However, documentation revealed that multiple residents went between five and seven days without a bowel movement, and there was no evidence that the bowel protocol was initiated as required. Certified Nurse Assistants were responsible for charting bowel movements every shift, but the lack of follow-through by licensed nurses resulted in prolonged periods without intervention. Interviews with staff confirmed that the expected protocol was not followed. An LPN was unable to provide documentation that interventions were started for several residents, and a Resident Care Manager acknowledged that the protocol was not initiated for at least two residents after reviewing their records. The Director of Nursing Services also stated that it was the expectation for nurses to assess and initiate the protocol, but this did not occur. The residents affected included those who were moderately cognitively impaired as well as those who were alert and oriented, and the failure to provide timely bowel management interventions was confirmed through both record review and staff interviews.