Failure to Monitor and Treat Constipation According to Bowel Protocol
Penalty
Summary
Surveyors identified that the facility failed to monitor bowel status and administer PRN medications to prevent constipation for three residents out of six sampled. For one resident with intact cognitive function and dependent for toileting, the care plan included a diagnosis of constipation but lacked interventions for prevention. Bowel monitoring forms showed multiple extended periods without documented bowel movements, some lasting up to 11 days, and medication administration records revealed that no bowel medications were given during these times, despite clear physician orders and a facility bowel protocol outlining specific interventions for consecutive days without a bowel movement. Interviews with staff and the DON confirmed that the bowel protocol was not followed and that no medications were administered as required. Another resident, admitted with multiple diagnoses including constipation, also experienced repeated periods with no documented bowel movements, sometimes for up to a week. Medication administration records for several months showed that no PRN bowel medications were given, even though physician orders and the facility's bowel protocol required specific interventions after two or more days without a bowel movement. The DON confirmed that the bowel management program was not followed for this resident and that the physician was not contacted when the resident exceeded five days without a bowel movement. A third resident, with severe cognitive impairment and total dependence on staff for toileting, was also found to have multiple periods with no documented bowel movements, some lasting up to ten days. The care plan did not address the risk for constipation or include interventions to prevent it. Despite having PRN bowel medications ordered, medication administration records showed that none were administered during the relevant periods. Staff interviews confirmed that the bowel protocol was not implemented for this resident, and the DON acknowledged that the required interventions were not provided.