Failure to Provide Timely Bowel Management Interventions
Penalty
Summary
The facility failed to provide necessary care and services for a resident at risk for constipation, as required by their own policies and physician orders. The resident, who had decreased mobility and was at risk for constipation due to possible medication side effects, was to have their bowel movements monitored every shift, with interventions such as prune juice, medications, and physician notification if no bowel movement occurred for more than three days. Despite these orders, the resident did not have a bowel movement from 5/30 to 6/6, and as-needed bowel management medications were not administered as ordered until six days after the last recorded bowel movement. During this period, the resident experienced abdominal distention, nausea, and vomiting. Medical record review showed that the resident was administered some scheduled bowel management medications, but the escalation to as-needed interventions, including Milk of Magnesia, Dulcolax suppository, and Fleet Enema, was delayed. Nursing staff and the DON confirmed that the as-needed medications were not provided in a timely manner according to the physician's orders. The resident's condition worsened, leading to transfer to an acute hospital, where a small bowel obstruction was diagnosed.