Failure to Revise Care Plan for Constipation Management
Penalty
Summary
The facility failed to revise and update the care plan for a resident who was at risk for constipation, despite ongoing changes in the resident's condition. The care plan initially addressed the risk for constipation related to decreased mobility and possible medication side effects, with interventions such as monitoring and recording bowel movements every shift, reporting abnormal stool, and notifying the physician if there was no bowel movement for more than three days. However, when the resident experienced no bowel movement for more than three days, along with symptoms of abdominal distention, nausea, and vomiting, the care plan was not updated to include additional or different interventions. Medical record review showed that the resident continued to have no bowel movement and worsening symptoms, leading to the administration of a fleet enema and eventual transfer to an acute care hospital due to persistent constipation and related symptoms. Interviews with facility staff, including an LVN and the DON, confirmed that the care plan was not revised in response to the resident's ongoing issues. The facility's policy required care plans to be updated when a resident's condition changed or when desired outcomes were not met, but this was not followed in this case.