Failure to Administer and Document Bowel Care Interventions per Physician Orders
Penalty
Summary
The facility failed to follow its bowel care standing orders and physician directives for administering specific medications when residents did not have a bowel movement within 72 hours. For five residents with various complex medical conditions, including respiratory failure, morbid obesity, schizoaffective disorder, cancer, osteolysis, malnutrition, femur fracture, diabetes, multiple sclerosis, and quadriplegia, there were multiple documented instances where no bowel movement occurred for periods exceeding 72 hours—sometimes up to 240 hours—without any documented nursing intervention or administration of prescribed bowel care medications. The facility's standing orders required timely administration of medications such as Peri Colace, MiraLAX, Milk of Magnesia, Bisacodyl, and Lactulose, and mandated provider notification if symptoms persisted, but these protocols were not followed as documented in the residents' records. Record reviews and staff interviews confirmed that nurses did not document the administration of bowel care medications or interventions as ordered for the affected residents during the periods of constipation. In some cases, physician orders specifically outlined a stepwise approach to bowel management, including escalation to suppositories or enemas if initial interventions were ineffective, but there was no evidence these steps were taken or recorded. The DON acknowledged that the required interventions and documentation were not completed by the nursing staff for the residents identified.