Failure to Implement Bowel Management Program for Two Residents
Penalty
Summary
The facility failed to implement its bowel management program as outlined in its policy and procedure, resulting in inadequate prevention and management of constipation for two residents. For one resident, who was always incontinent of bowels and taking medications known to cause constipation, there were multiple documented periods of three to five days without a bowel movement. During these periods, there was no evidence of gastrointestinal assessments, progress notes, or administration of bowel medications as required by the facility's protocol. The Medication Administration Record showed only a single administration of a bowel medication, with no further interventions or documentation of effectiveness, and the Director of Nursing confirmed that the protocol was not followed. For another resident, documentation showed several episodes of three to four days without a bowel movement. Although there was a physician's order for a PRN bowel medication, there was no evidence in the Medication Administration Record or progress notes that the medication was administered during these episodes. Additionally, there were no assessments or interventions documented in response to the lack of bowel movements, despite the resident being under a fluid restriction and having a care plan that addressed bowel continence. Interviews with nursing staff confirmed the lack of documentation and intervention according to the facility's bowel management protocol.