Failure to Obtain Physician Orders and Timely Follow Bowel Protocol
Penalty
Summary
The facility failed to obtain required physician orders for two residents who went on therapeutic leave and did not follow the established bowel protocol in a timely manner for another resident. Specifically, two residents with diagnoses including vascular dementia, kidney disease, congestive heart failure, Alzheimer's disease, hypothyroidism, and a history of repeated falls were documented in nurse progress notes as being on leave with family, but there were no corresponding physician orders authorizing these therapeutic leaves. The Director of Nursing confirmed that the required orders were not present in the clinical records for these residents. Additionally, a resident with high blood pressure, hyperlipidemia, and Alzheimer's disease experienced significant lapses between documented bowel movements, with intervals ranging from five to seven days. During these periods, there was no evidence in the clinical record of abdominal assessments or timely interventions as outlined in the facility's bowel protocol. The first intervention, administration of bisacodyl, was not provided until after a prolonged lapse, and the Director of Nursing confirmed the protocol was not followed in a timely fashion.