Failure to Follow Physician-Ordered Bowel Protocol
Penalty
Summary
Facility staff failed to follow physician orders for a prescribed bowel protocol for a resident with a history of congestive heart failure, chronic obstructive pulmonary disease, and Type 2 diabetes. The physician's orders specified a stepwise bowel regimen involving Milk of Magnesia, Dulcolax suppository, and Fleet Enema, to be administered if the resident did not have a bowel movement within specified timeframes, with documentation of effectiveness and notification of the physician if the protocol was ineffective. Despite these orders, the resident went four consecutive days without a bowel movement, and there was no documented evidence that the prescribed bowel protocol was administered during this period. The resident reported frequent constipation and described a recent episode of significant straining that resulted in hemorrhoids and rectal bleeding. Review of the Medication Administration Record confirmed that nursing staff did not implement the bowel protocol as ordered. The Director of Nursing acknowledged that staff failed to carry out the physician's orders. Additionally, the facility was unable to provide a written policy regarding bowel elimination management.