Failure to Timely Implement Bowel Protocol Resulting in Harm
Penalty
Summary
The facility failed to implement its bowel protocol in a timely manner for residents who had not had bowel movements, resulting in actual harm to one resident and placing another at risk for harm. For one resident with Parkinson's Disease, peripheral vascular disease, and dementia, there was no recorded bowel movement for five days. Despite care plan interventions and physician orders specifying a stepwise bowel protocol to be initiated after three days without a bowel movement, there was no evidence that any of the prescribed interventions—Milk of Magnesia, Bisacodyl suppository, or Fleet enema—were administered. Documentation and staff interviews confirmed that the bowel protocol was not followed, and no assessment for constipation or bowel sounds was documented during this period. The resident subsequently experienced abdominal pain and multiple episodes of emesis with fecal odor, prompting transfer to the emergency room. Hospital records indicated the resident was admitted for dehydration and constipation, with imaging revealing a moderate to large amount of retained stool and possible fecal impaction. Interviews with staff, including the RN, CNA, ADON, DON, and NP, confirmed that the bowel protocol was not implemented as required, and communication lapses occurred regarding the resident's bowel status. The DON and ADON acknowledged that the protocol should have been initiated and that the necessary medications were available but not administered. A second resident with a diagnosis of constipation also did not receive timely intervention after three days without a bowel movement, as required by the facility's bowel protocol. The resident reported not receiving requested interventions such as prune juice or a laxative. Review of records confirmed that the bowel protocol was not implemented, and the DON verified that interventions should have been provided. The facility's policy required monitoring and prompt intervention for constipation, but this was not followed for either resident, as evidenced by the lack of documentation and administration of prescribed treatments.