Failure to Monitor and Intervene for Bowel Elimination Needs
Penalty
Summary
A deficiency was identified when a resident with multiple complex medical conditions, including multiple sclerosis, aphasia, anoxic brain damage, and severe cognitive impairment, did not receive appropriate monitoring and intervention for bowel movements as outlined in their care plan. The resident was dependent on staff for all toileting and hygiene needs and was always incontinent of bowel and bladder. The care plan required staff to record bowel movements, report abnormalities, and notify the physician of any changes in bowel function, including no bowel movement for three days. Despite these interventions, the resident did not have a documented bowel movement for a period of nine days. During this time, there was no evidence that as-needed bowel medications were administered, nor was there documentation that the physician was notified of the absence of bowel movements. Nursing notes and the medication administration record confirmed that no bowel interventions were provided, and staff did not follow the established protocol for monitoring and responding to constipation. The facility's staff described a bowel program that should have triggered interventions after 48 to 72 hours without a bowel movement, but this was not implemented for the resident in question. The lack of intervention led to the resident being diagnosed with a possible small bowel ileus after presenting with vomiting, high tube feeding residuals, and minimal bowel sounds. The facility did not have a written bowel monitoring policy, and staff acknowledged that no as-needed bowel medications were given during the period of concern. The deficiency was based on the failure to provide appropriate treatment and services to monitor and address the resident's bowel elimination needs according to physician orders and the resident's care plan.