Failure to Initiate Bowel Protocol per Policy and Physician Orders
Penalty
Summary
The facility failed to initiate bowel interventions in accordance with physician orders and facility policy for three residents who experienced extended periods without a bowel movement. The facility's policy required licensed nurses to assess residents and begin a bowel protocol if no or minimal bowel movement was documented for 64 hours. This protocol included administering Milk of Magnesia, followed by Bisacodyl suppository, and then a Fleet Enema if previous interventions were ineffective, as outlined in the residents' physician orders. For one resident, documentation showed a gap of approximately 118 hours between bowel movements, with no evidence in the Electronic Medication Administration Record (EMAR) that the prescribed interventions were administered after the 64-hour threshold. Another resident experienced a 121-hour interval between bowel movements, and again, the EMAR did not reflect any medication intervention as required by the protocol. A third resident had a 130-hour gap between bowel movements, with no documentation of bowel protocol interventions during this period. Interviews with nursing staff and the Director of Nursing confirmed that the bowel protocol was not initiated as expected and that there were issues with documentation. Staff acknowledged that there should have been records of interventions during the periods of no bowel movement, but none were found. The failure to follow the established bowel management protocol resulted in unmet care needs for the affected residents.