Failure to Discontinue Laxative During C. diff Infection Resulting in Severe Weight Loss and Dehydration
Penalty
Summary
The facility failed to provide treatment and care in accordance with professional standards, the resident's care plan, and the resident's preferences for one resident diagnosed with C. diff on two occasions. Despite the resident experiencing persistent and severe diarrhea, the facility continued to administer a prescribed laxative (Bisacodyl) daily, as ordered for constipation, without reassessment or discontinuation. The resident's care plan included an intervention to notify the physician if persistent diarrhea occurred, but this was not done. Multiple staff members, including nursing assistants and medication aides, observed the resident's ongoing diarrhea and significant weight loss, but did not ensure that the nurse practitioner was notified or that the laxative was discontinued. The resident, who was severely cognitively impaired and always incontinent of bowel, experienced a dramatic weight loss of 25 pounds (27.8%) over approximately six weeks, as well as dehydration, elevated troponin levels, and acute kidney injury. Laboratory results confirmed repeated C. diff infections, and hospital records documented acute kidney injury, dehydration, and uremia. Interviews with staff revealed a lack of communication and follow-through regarding the resident's symptoms and weight loss, with some staff assuming others would notify the nurse practitioner or that the symptoms were expected due to the C. diff diagnosis. The facility's policies required prompt notification of the physician for significant changes in condition, including persistent diarrhea and significant weight loss, but these policies were not followed. The nurse practitioner was not made aware of the continued administration of the laxative or the extent of the resident's symptoms and weight loss. As a result, the resident continued to receive a medication that likely exacerbated her diarrhea and contributed to her decline, without appropriate clinical reassessment or intervention.