Failure to Follow Bowel Protocol for Constipation Management
Penalty
Summary
The facility failed to follow its bowel protocol for constipation management for two residents who were at risk due to their medical conditions and dependency on staff for toileting. For one resident with osteoarthritis, spinal stenosis, anxiety, major depressive disorder, type 2 diabetes, and chronic pain, the care plan required monitoring and recording bowel movements every shift and administering as-needed laxatives if no bowel movement occurred in three days. Despite this, documentation showed the resident did not have a bowel movement for five days, and no as-needed laxatives were administered during that period. The registered nurse confirmed there was no system in place to ensure the bowel protocol was followed. Similarly, another resident with major depressive disorder, chronic kidney disease, urinary retention, and anxiety disorder, who was also always incontinent and dependent on staff, did not have a bowel movement for four days. The care plan included several as-needed interventions for constipation, but no as-needed laxatives were given, and there was no documentation of the bowel protocol being followed. The registered nurse again verified the lack of a system to ensure adherence to the protocol. Both cases were confirmed through record review, standing orders, and staff interviews.