Failure to Follow Bowel Management Protocol and Physician Orders
Penalty
Summary
The facility failed to follow its established bowel management protocol for five residents whose records were reviewed for bowel and bladder care. According to the protocol, if a resident does not have a bowel movement within 48-72 hours, a series of progressive interventions, including administration of Bisacodyl tablets, suppositories, and enemas, should be implemented and documented. However, documentation revealed that for several residents, there were significant gaps between bowel movements—ranging from 120 to 144 hours—without evidence that the bowel management protocol was initiated or followed as ordered. Medication Administration Records (MARs) and CNA Task Bowel Activity logs showed that the required interventions were either not started in a timely manner or not documented as completed, despite the absence of bowel movements for extended periods. Specific examples include a resident with a history of femur fracture and depression who went five days without a bowel movement and did not have the protocol initiated, and another resident with Huntington’s disease and anxiety who experienced a prolonged period without a bowel movement despite multiple steps of the protocol being initiated without documented results. Additional residents with chronic kidney disease, PTSD, and dementia also experienced similar lapses, with the protocol either not started or not fully documented. The Director of Nursing confirmed that nursing staff did not document following all steps of the bowel protocol as required.