Failure to Follow Bowel Protocol and Physician Orders for Cognitively Impaired Resident
Penalty
Summary
The facility failed to follow physician's orders and its own bowel protocol policy for a resident who was cognitively impaired, required assistance with daily care, was always incontinent of bowel, and had a diagnosis of paranoid schizophrenia. According to the facility's policy, if a resident has not had a bowel movement for three full days, the licensed nurse is to follow the bowel protocol as ordered by the physician, which includes administering a laxative and monitoring for effectiveness, with further interventions if needed. For this resident, there were multiple documented periods where no bowel movement occurred for more than three days, but there was no evidence that the prescribed 30 ml of Milk of Magnesia Suspension was offered or administered as required after the third day/ninth shift of no bowel movement. On one occasion, the laxative was administered five days after the last bowel movement, but it was ineffective and no further interventions were documented. Additional periods of five or more days without a bowel movement were also noted, with no documentation that the bowel protocol was followed or that the resident was offered or declined the medication. The DON confirmed that staff did not follow the facility's bowel policy and physician's orders for the resident on the identified dates.
Plan Of Correction
R42 is care planned as non-complaint with taking medications including medications ordered as part of the bowel protocol. R42 is care planned as combative and easily agitated and at times will not allow staff to touch him, which includes bowel protocol measures ordered. Resident 42 was ordered MiraLAX for constipation. Staff will encourage resident to take bowel protocol medications as ordered. Re-education will be complete by the Director of Nursing for all licensed nursing staff on following bowel protocols and documentation of refusals. An audit was conducted of all residents during the annual survey to ensure all residents that had not had a bowel movement after day 3 were given bowel protocols completed as ordered. The Director of Nursing or designee will audit whether the bowel protocol is being followed per order daily for 6 weeks. The audit outcomes will be presented to the Quality Assurance Committee for review and recommendations.