Failure to Administer and Document Bowel Care per Physician Orders
Penalty
Summary
The facility failed to follow physician orders for bowel care management for four residents with multiple diagnoses, including post-surgical amputation, obesity, dementia, anxiety, Alzheimer's disease, chronic kidney disease, and transient cerebral ischemic attack. For each resident, physician orders specified a stepwise administration of medications such as Bisacodyl tablets, Dulcolax suppositories, Fleet enemas, and Polyethylene Glycol to be given if a bowel movement (BM) did not occur within a specified number of days. Despite these orders, documentation showed that each resident went over 100 hours without a BM, and there was no record of the required medications being administered during these periods. Staff interviews confirmed that nurses had not documented any bowel medication interventions for these residents during the relevant timeframes, despite the absence of BMs and the presence of standing orders. The Chief Nursing Officer (CNO) acknowledged that the nurses should have documented and administered the prescribed interventions according to the physician's orders. This lack of adherence to physician orders and failure to document interventions was observed for all four residents reviewed for bowel and bladder care.