Failure to Monitor and Respond to Resident Constipation
Penalty
Summary
The facility failed to adequately monitor and respond to a resident's lack of bowel movements, despite the resident having a history of severe cognitive impairment, incontinence, and a diagnosis of constipation. The resident's care plan directed staff to monitor for constipation and administer laxatives as needed if no bowel movement occurred in three days. However, electronic medical records showed that the resident went up to nine consecutive days without a bowel movement or treatment, and up to eight consecutive days on another occasion, with no medication given for constipation and no assessment documented during these periods. Documentation of bowel movements and follow-up after administration of laxatives was incomplete or missing. Interviews with staff revealed inconsistencies in monitoring and documentation practices. Certified Medication Aides and Licensed Nurses stated that bowel movements were supposed to be tracked and that nurses should assess and notify providers if a resident went three days without a bowel movement. However, the administrative nurse acknowledged that Certified Nurse Aides did not always document bowel movements in the EMR, and that nurses did not consistently follow up on EMR alerts for missed bowel movements. The facility did not provide a policy addressing the monitoring of residents to prevent constipation.