Failure to Administer Bowel Care Medications per Physician Orders
Penalty
Summary
The facility failed to follow professional standards of practice for bowel and bladder care for five residents with physician orders for bowel management. Each resident had specific orders for the administration of medications such as Milk of Magnesia, Dulcolax suppositories, and Fleet Enemas to be given if a bowel movement did not occur within a specified timeframe. Despite documented periods of three or more days without a bowel movement, the medication administration records showed that these residents did not receive the prescribed interventions. For example, one resident with dementia and poor decision-making ability did not have a bowel movement for four days and was not given any bowel care medications as ordered. Another resident, who was cognitively intact, experienced constipation for up to six days and reported having to request bowel medications from nursing staff, rather than being proactively offered them according to the physician's orders. The Director of Nursing (DON) confirmed upon review that nursing staff should have tracked bowel movements and administered medications as ordered when residents had not had a bowel movement within the specified period. Similar deficiencies were observed for the other residents reviewed, including those with impaired decision-making and those requiring cues or supervision. In each case, the residents' bowel movement records indicated extended periods without a bowel movement, and the corresponding medication administration records showed that the prescribed bowel care interventions were not provided. Staff interviews and record reviews confirmed that the facility did not adhere to the physician's orders for bowel management for these residents.