Failure to Develop Comprehensive Care Plan for Constipation
Penalty
Summary
The facility failed to develop and maintain a comprehensive care plan addressing constipation for a resident with dementia, severe cognitive impairment, and who was receiving hospice and palliative care. Despite multiple physician and hospice orders for bowel management, including scheduled and as-needed laxatives and suppositories, the resident's care plan did not include interventions for bowel or bladder incontinence or constipation. The care plan did address other areas such as hospice, opioid use, and pain management, but omitted bowel issues, even though the resident was dependent on staff for all activities of daily living and had severely impaired communication abilities. Observations and interviews revealed that the resident experienced multiple extended periods without a documented bowel movement, and family members and staff noted signs of discomfort and pain that were not verbally communicated by the resident. The family reported an emergency room visit due to constipation, and staff acknowledged the need for a care plan to address constipation, especially given the resident's opioid use. The director of nursing confirmed the absence of a care plan for constipation, and facility policy required individualized care plan interventions for bowel management based on assessment and resident response.