Failure to Assess and Intervene for Bowel Obstruction
Penalty
Summary
A deficiency occurred when the facility failed to assess, monitor, and intervene for a resident who had not had a bowel movement for several days, despite the resident's care plan indicating the need to check bowel sounds and notify a physician if no bowel movement occurred for three days. The resident, who had diagnoses including constipation, cerebral palsy, and intellectual disabilities, was always incontinent of bowel and required staff assistance for activities of daily living. Bowel elimination records showed the resident had no bowel movement for five consecutive days, followed by a single medium-sized bowel movement, and then again no bowel movement for two days. During this period, the resident began experiencing symptoms such as nausea and vomiting, which were documented in progress notes. Despite these symptoms and the absence of bowel movements, there was no documented nursing assessment related to the vomiting or constipation. Staff interviews revealed that CNAs were expected to report lack of bowel movements to nurses, but there was confusion about the process and lack of access to electronic medical records for some staff. The ADON confirmed that there was no policy in place for assessing and monitoring bowel movements at the time, and that intervention should have started at the beginning of the fourth day without a bowel movement. The resident's condition worsened, leading to transfer to the emergency room for self-harm, altered mental status, and low blood pressure. A CT scan at the hospital revealed a high-grade small bowel obstruction, and the resident was admitted for further evaluation. Family members reported that the resident had been complaining of stomach pain and refusing to eat prior to hospitalization, and that these concerns had been communicated to facility staff.