Failure to Implement Standing Orders for Constipation Management
Penalty
Summary
The facility failed to develop and implement a comprehensive, person-centered care plan and physician's orders for a resident with a history of constipation. The resident, who had diagnoses including Alzheimer's disease, diabetes mellitus, and cerebral infarction, was assessed as moderately cognitively impaired and always incontinent of bowel. The care plan identified a risk for inadequate bowel pattern and included interventions such as administering medication as ordered and monitoring for signs of constipation. However, despite standing physician's orders for laxatives to be administered if no bowel movement occurred in three days, the resident did not receive the prescribed medications. Review of the resident's records showed no bowel movements for six consecutive days, and the Medication Administration Record confirmed that neither milk of magnesia nor bisacodyl was given during this period. Interviews with the resident, an LPN, and the DON confirmed the lack of medication administration despite the standing orders and the resident's ongoing constipation. The failure to follow the care plan and physician's orders resulted in the deficiency.