Failure to Initiate Bowel Management Protocol per Standing Orders
Penalty
Summary
The facility failed to follow its established bowel care standing orders for administering specific medications when residents did not have a bowel movement (BM) within 72 hours. According to the facility's routine standing orders, medications such as Miralax, Senna, Dulcolax, and Magnesium Citrate were to be used as needed for constipation if a resident had not had a BM within the specified timeframe. However, documentation review revealed that for two residents, the bowel management protocol was not initiated as required. One resident, with a history of stroke and chronic obstructive pulmonary disease, went 96 hours between BMs without the protocol being started. Another resident, diagnosed with diabetes and chronic respiratory failure with hypoxia, experienced two separate intervals of 84 and 117 hours without a BM, during which the bowel management protocol was also not initiated. Staff interviews confirmed that the expectation was to begin the bowel management protocol when a resident had not had a BM for 72 hours or more, but this was not done for the affected residents. The medication administration records (MARs) for both residents showed no evidence that the protocol was followed during the periods of constipation, despite clear documentation in the CNA Task Bowel Activity logs indicating the extended intervals without BMs.