Failure to Monitor and Intervene for Constipation in Two Residents
Penalty
Summary
The facility failed to monitor and intervene appropriately for constipation in two residents with significant medical histories, including chronic obstructive pulmonary disease, diabetes, heart disease, and other chronic conditions. For one resident, records showed a six-day period without a bowel movement, despite physician orders for both scheduled and as-needed medications for constipation and an order to monitor for medication side effects, including constipation. There was no documentation that the resident was assessed for constipation or offered the as-needed medication during this period. For the second resident, a five-day period without a bowel movement was documented, despite orders for daily and twice-daily medications for constipation and instructions to monitor for constipation every shift. Again, there was no documentation of assessment for constipation during this time. Interviews with the DON, Administrator, and an RN confirmed that the facility's standard of practice is to monitor daily bowel movements, assess for constipation, and initiate interventions after three days without a bowel movement. The absence of documentation and lack of intervention for both residents was confirmed by the DON. The findings were based on medical record review, staff interviews, and reference to national clinical guidelines, and represent continued non-compliance from a previous survey.