Failure to Provide Timely Bowel Care and Notify Provider for Resident with Constipation
Penalty
Summary
A deficiency was identified when a resident with Parkinson's Disease, constipation, and irritable bowel syndrome did not receive timely treatment or interventions for constipation, as required by the facility's bowel protocol. The resident did not have a bowel movement for several days after admission, and there was no documented evidence that bowel interventions were implemented in accordance with the protocol. The resident's prescribed bowel medication, Linzess, was not available or administered for several days, and there was no documentation that the medical provider was notified of the missed doses or the resident's ongoing constipation. The facility's bowel protocol required certified nursing assistants to record bowel movements every shift and licensed nursing staff to monitor bowel patterns daily, applying interventions as needed. However, documentation showed that the resident went multiple days without a bowel movement, and interventions such as suppositories were delayed or not documented. Additionally, the medical provider was not notified when the resident failed to have a bowel movement for several days, nor when bowel medications were unavailable. The resident's care plan did not address constipation as a problem area, and there was no plan for ongoing management of the resident's constipation. Interviews with staff revealed inconsistencies in following the bowel protocol, uncertainty about the accuracy of bowel movement tracking reports, and a lack of communication regarding interventions and outcomes. The electronic system used to track bowel movements did not consistently transfer accurate data, leading to discrepancies between reports and actual documentation. Ultimately, the resident was transferred to the hospital with a diagnosis of fecal impaction after experiencing chest pain and diaphoresis, and hospital records confirmed ongoing constipation and the need for multiple interventions.