Failure to Implement Bowel Management Interventions for a Resident with Constipation
Penalty
Summary
A deficiency occurred when staff failed to monitor and provide appropriate interventions for bowel management for a resident with a history of constipation and multiple comorbidities, including vascular dementia, diabetes mellitus type 2, and hypertension. The resident required substantial assistance with activities of daily living and was always continent of bowel. The care plan directed staff to notify a nurse and implement bowel management protocols if the resident had no bowel movement for three days. Physician orders included several laxatives to be administered as needed for constipation, and the facility's standing orders outlined a stepwise approach for intervention after three days without a bowel movement. Despite these protocols, the resident did not have a bowel movement for six consecutive days, and there was no documentation that staff provided any interventions during this period. Observations revealed the resident was found with fecal incontinence and required assistance to be cleaned. Interviews with staff confirmed that interventions were not implemented as required by the care plan and standing orders, and the nurse was unable to find evidence of any action taken during the period of constipation.