Failure to Adequately Monitor and Intervene for Constipation
Penalty
Summary
The facility failed to ensure adequate monitoring and timely interventions for constipation in a resident with a history of hemiplegia, hemiparesis following a stroke, and epilepsy. The resident was identified as being at risk for constipation due to decreased mobility and medication side effects, with care plan interventions including daily bowel movement documentation, following the facility's bowel protocol, and monitoring for complications. Despite these interventions, the resident experienced a period of over five days without a documented bowel movement, during which time there were also complaints of nausea and abdominal pain. The facility's bowel protocol required interventions if a resident had not had a bowel movement in three days, but there was a delay in implementing effective treatment. During this period, the resident received docusate sodium and later Miralax, but bowel movements remained infrequent and ineffective. The resident's condition worsened, with increasing abdominal pain and continued inability to have a bowel movement, eventually requiring a Fleet enema and subsequent transfer to the hospital. Hospital evaluation revealed significant stool retention and proctitis. Documentation and interviews confirmed that the facility did not consistently follow its bowel management protocol or promptly escalate care as required by the resident's condition and care plan.