Failure to Prevent Constipation in Resident on Pain Medication
Penalty
Summary
The facility failed to provide effective bowel management for a resident who was prescribed pain medications known to cause constipation. The resident had multiple diagnoses, including dependence on supplemental oxygen, heart failure, spinal stenosis, type II diabetes, and atrial fibrillation, and was moderately cognitively impaired. Physician orders included tramadol and a fentanyl patch for pain management. Despite these medications, which increase the risk of constipation, the resident's bowel movements were not adequately monitored or managed, as evidenced by documentation showing only small bowel movements on two days and none for the following five days. Staff interviews revealed that the nurse practitioner was not made aware of any constipation concerns, and the assistant director of nursing acknowledged that the resident's hospital stay for fecal impaction was preventable. The resident was ultimately hospitalized with severe fecal impaction, confirmed by CT scan, and required disimpaction and an enema. Facility policy required documentation of bowel movements and physician notification for changes in bowel patterns, but these procedures were not effectively implemented for this resident.