Failure to Follow Bowel Protocol and Physician Orders for Constipated Resident
Penalty
Summary
The facility failed to follow physician's orders and its own bowel protocol for a resident identified as being at risk for complications due to constipation. According to the facility's policy, if a resident does not have a bowel movement after three days, Milk of Magnesia (MOM) should be administered, followed by a Dulcolax suppository on day four if MOM is ineffective, and a saline enema on day five if both previous interventions fail. For the resident in question, the bowel record showed no bowel movement for six consecutive days. While MOM was administered on the third day without effect, there was no documented evidence that the Dulcolax suppository was given on the fourth day or that a saline enema was administered on the fifth day, as required by both physician's orders and facility protocol. The resident was cognitively intact, frequently incontinent of bowel and urine, and required assistance with transfers and hygiene. She reported recent constipation during an interview. The DON confirmed that the bowel protocol was not followed for this resident during the specified period. Clinical record reviews and staff interviews corroborated that the required interventions were not provided or documented as ordered.