Failure to Monitor and Treat Constipation According to Physician Orders
Penalty
Summary
A deficiency occurred when the facility failed to provide necessary care and services for a resident with a history of metabolic encephalopathy, atrial fibrillation, hypertension, and acute osteomyelitis. The resident was identified as being at risk for complications related to constipation due to immobility and medication side effects. The care plan included interventions to administer medications for constipation as ordered by the physician. Despite physician orders for a bowel regimen that included Milk of Magnesia, Dulcolax suppository, and Fleet Saline Enema to be administered as needed for constipation, the resident did not have a bowel movement for three consecutive days. Documentation showed that the resident's Activities of Daily Living (ADL) records indicated no bowel movement on those days, but no medications for constipation were administered as required by the orders. Interviews with staff revealed that the Certified Nursing Assistant (CNA) did not notify the charge nurse of the resident's constipation, and the Licensed Vocational Nurse (LVN) did not recall receiving an alert or being notified. As a result, the resident did not receive the prescribed interventions for constipation. Further review of facility policies and job descriptions confirmed that CNAs are required to report changes in residents' conditions to the nurse supervisor, and LVNs are responsible for reviewing charts and evaluating residents' conditions. The Director of Staff Development and the Director of Nursing both acknowledged that the staff should have monitored the resident's bowel movements and administered the prescribed medications for constipation according to the care plan and physician orders.