Failure to Address Bowel Elimination in Resident Care Plan
Penalty
Summary
A deficiency was identified when the facility failed to develop and implement a comprehensive, person-centered care plan that addressed all of a resident's needs, specifically regarding bowel elimination. The resident, who had multiple diagnoses including schizophrenia, Parkinsonism, generalized anxiety disorder, obsessive-compulsive disorder, major depressive disorder, congestive heart failure, and peripheral vascular disease, reported experiencing constipation over the previous two months, with extended periods without a bowel movement. Medical records confirmed physician orders for Milk of Magnesia to treat constipation, but the medication was not administered during the month reviewed. Documentation showed the resident went up to six days without a bowel movement on one occasion and three days on another within a 30-day period. The resident's care plan, initially created for ADL self-care performance deficits related to schizophrenia, only addressed urinary elimination and did not include any interventions or monitoring for bowel elimination or constipation. The care plan's toileting focus area had not been updated to reflect the resident's bowel elimination needs, despite evidence of ongoing constipation and physician orders for treatment. The DON confirmed that the care plan only addressed urinary elimination and not bowel elimination.