Failure to Ensure Staff Competency in Bowel Management and Communication
Penalty
Summary
The facility failed to ensure that a certified nursing assistant (CNA) and a licensed vocational nurse (LVN) demonstrated appropriate competency in caring for and reporting episodes of diarrhea in a resident. The resident, who was cognitively intact and at risk for pressure injuries and moisture-associated skin damage (MASD), had physician orders for docusate sodium and senna for bowel management, with explicit instructions to hold these medications if the resident experienced loose stools. Despite these orders, the resident continued to receive both medications on multiple days when documentation and interviews confirmed the presence of loose or watery stools. Record reviews showed that the resident had several episodes of loose stools documented throughout the month, yet the medication administration record indicated that the bowel management medications were administered on those same days. Interviews revealed that the CNA observed and documented the loose stools and reported them to an unknown charge nurse, but the LVN assigned to the resident was not informed and proceeded to administer the medications as scheduled. The LVN stated that he would have held the medications if he had been aware of the loose stools and would have reported a change of condition if there were multiple episodes. The Director of Nursing (DON) confirmed that the facility's protocol required CNAs to notify nurses of changes such as loose stools and that nurses should hold bowel management medications per physician orders in such cases. The DON also verified that the resident received the medications on days when loose stools were documented, contrary to the physician's instructions. Facility job descriptions for both CNAs and LVNs outlined the responsibility to report changes of condition and administer medications as prescribed, but these protocols were not followed in this instance.