Failure to Follow Bowel Protocol for Resident with Constipation
Penalty
Summary
A deficiency was identified when a resident with multiple medical diagnoses, including schizophrenia, Parkinsonism, generalized anxiety disorder, obsessive-compulsive disorder, major depressive disorder, congestive heart failure, and peripheral vascular disease, experienced episodes of constipation that were not managed according to the facility's established bowel protocol. The resident reported experiencing constipation over the previous two months and indicated that he had gone extended periods without a bowel movement. Despite having physician orders for Milk of Magnesia (MOM) to be administered as needed for constipation, and a specific order to administer MOM on the third day without a bowel movement, the medication was not given during the month in question, as documented in the Medication Administration Record (MAR). Review of the resident's bowel elimination records showed multiple instances where the resident went three or more days without a bowel movement, including a six-day period and a three-day period. The facility's bowel protocol required staff to initiate treatment with MOM after three days without a bowel movement, followed by additional interventions if the initial treatment was ineffective. However, there was no documentation that the protocol was followed, that MOM was administered or refused, or that subsequent steps were taken as required by the protocol. Interviews with facility staff, including an LPN, a CNA, and the DON, revealed a lack of clarity regarding the location and implementation of the bowel protocol. The DON confirmed that the protocol should have been initiated and that documentation of administration or refusal should have been present in the MAR or nurse progress notes. The resident's care plan also did not address bowel elimination patterns or treatment for constipation, and there was no evidence that the required interventions were provided or documented during the periods of constipation.