Failure to Prevent and Manage Constipation Resulting in Fecal Impaction
Penalty
Summary
The facility failed to provide necessary treatment and services to prevent constipation for a resident with severe cognitive impairment, central cord syndrome, and toxic encephalopathy. The resident was admitted with significant care needs, including substantial to maximal assistance for toileting and was prescribed both polyethylene glycol and sennosides for constipation. Despite these interventions, the resident experienced a decline in oral intake and had no recorded bowel movements for seven consecutive days. According to the facility's Bowel Management policy, residents who do not have a bowel movement for three days should be placed on the bowel program and, if ineffective, the medical provider should be notified within 24 to 32 hours for further orders. Documentation and staff interviews revealed that the resident was not placed on the bowel program as required, and the medical provider was not notified of the ongoing constipation. Multiple staff members confirmed that the resident's lack of bowel movements should have triggered additional interventions and provider notification, but there was no evidence of such actions in the medical record. As a result of these omissions, the resident developed a fecal impaction, significant rectal distention, dehydration, and a urinary tract infection, necessitating emergency department evaluation and treatment. The medical provider was only contacted after seven days without a bowel movement, and new orders were obtained following the resident's return from the hospital. Staff and leadership interviews confirmed that the facility's bowel management protocol was not followed, and the required notifications and interventions were not implemented in a timely manner.