Failure to Implement Bowel Protocol for Resident on Constipating Medication
Penalty
Summary
The facility failed to consistently implement a bowel protocol program for one resident who was admitted with chronic systolic congestive heart failure, protein-calorie malnutrition, and was receiving palliative and hospice care. The resident was prescribed Fentanyl, a medication known to cause constipation, and had a physician's order for Miralax to be administered as needed for constipation. However, medical record review showed multiple extended periods—ranging from four to over five days—without a documented bowel movement, and no documentation that Miralax was administered during these times. The Medication Administration Record for the month showed no evidence that the medication was given, despite the absence of bowel movements. Interviews with facility staff, including the DON, NHA, and a registered nurse, revealed that there was confusion and lack of clarity regarding the bowel protocol. The DON and NHA could not produce a current bowel protocol or explain the existing one, and the RN was unable to locate the protocol or specify the order of interventions. The Medical Director confirmed that the expectation was for staff to notify her after three days without a bowel movement and to administer Miralax as ordered, but this was not done. The facility did not have a current bowel policy in place at the time of the survey, and staff were unable to demonstrate consistent implementation of bowel management for the resident.