Failure to Follow Bowel Care Protocols and Obtain Physician Orders for IV Therapy
Penalty
Summary
The facility failed to follow its own standing orders for bowel care and did not obtain required physician orders for IV insertion and dressing changes. For one resident with chronic kidney disease and mobility issues, documentation showed significant gaps between bowel movements, with intervals of 120 and 180 hours, despite the resident's normal pattern of daily bowel movements. Although the resident was receiving a daily bowel maintenance medication as ordered by the physician, there was no documentation that the facility's standing order medications for constipation were administered during these periods. The Director of Nursing confirmed that staff should have followed the standing order and contacted the physician when the resident had not had a bowel movement within 72 hours, but this was not done. Additionally, another resident with a hip fracture and COPD was observed with an IV inserted, but there were no physician orders documented for the IV or for dressing changes in the medical record. The Director of Nursing confirmed that the IV was started and that orders should have been present in the record, but they were not. These findings indicate that the facility did not provide treatment and care according to physician orders and established protocols.