Failure to Follow Bowel and Bladder Care Protocols
Penalty
Summary
The facility failed to follow its bowel and bladder care protocols for two residents. For one resident with a history of cervical disc disorder and high risk for constipation due to pain medication and immobility, the facility did not implement the prescribed bowel regimen after three days without a bowel movement. Despite physician orders for a stepwise approach involving Docusate Sodium, Lactulose, and a mineral oil enema if no bowel movement occurred, the additional Lactulose and mineral oil enema were not administered as required. The resident experienced ongoing discomfort and bloating, and staff interviews confirmed that the bowel management protocol was not followed as ordered. For another resident with neuromuscular bladder dysfunction and urinary retention, the facility did not consistently document urine output as required by physician order and facility policy. The resident had an indwelling urinary catheter and was on a fluid restriction, necessitating close monitoring of urine output to prevent bladder distention. Record reviews revealed multiple missed entries for urine output across various shifts, and staff acknowledged that documentation was not completed as expected. Facility policies required licensed nurses to monitor and document bowel movements and urine output according to physician orders. However, in both cases, the required monitoring and interventions were not performed or documented, resulting in a failure to provide appropriate care for residents who were continent or incontinent of bowel and bladder.