Failure to Implement Bowel Program for Resident on Opioid Medication
Penalty
Summary
The facility failed to implement an appropriate bowel program for a resident who was prescribed Tramadol, an opioid known to increase the risk of constipation. The resident, who has severe cognitive impairment and is dependent on staff for toileting, had no scheduled bowel medications and did not receive any doses of as-needed Milk of Magnesia, despite documented periods of no bowel movements for several consecutive days. The resident's care plan did not address opioid use or the associated risk for constipation, and there was no evidence in the nursing notes that the resident was assessed for constipation or offered bowel interventions during these periods. Staff interviews confirmed that the electronic medical record system only triggered alerts after three days without a bowel movement, and the facility did not have a standardized bowel protocol, instead relying on individual assessment. The DON and nursing staff acknowledged the lack of a care plan addressing opioid-induced constipation and confirmed that the resident experienced occasional constipation, with no routine bowel medications ordered or administered. Documentation showed multiple instances of three or more days without a bowel movement, with no corresponding interventions recorded.