Failure to Revise and Implement Care Plan for Constipation Management
Penalty
Summary
The facility failed to implement, review, and revise the care plan and interventions for a resident at risk for constipation, resulting in a delay in treatment and subsequent medical complications. The resident, who had dementia and was cognitively impaired, was identified as being at risk for constipation due to decreased mobility, medication side effects, and opioid use. The care plan included interventions such as monitoring for signs and symptoms of constipation, administering medications as ordered, and reporting abnormal findings to the physician. However, documentation revealed that the resident went extended periods without bowel movements, specifically six days without a bowel movement and another ten-day period with only one medium bowel movement. Despite having PRN medications available for constipation relief, including stool softeners, laxatives, suppositories, and enemas, there was no documentation that any of these were administered during the periods of constipation. Progress notes indicated that the resident later experienced a large episode of dark brown emesis and was subsequently sent to the hospital for evaluation of fever and hypotension. Hospital records confirmed the development of a small bowel obstruction, acute kidney injury, and sepsis. Interviews and record reviews confirmed that the care plan was not followed or updated to reflect the resident's changing condition. The Director of Nursing acknowledged that the care plan should have been person-centered and interventions implemented to meet the resident's goals. Reference materials cited in the report emphasized the importance of revising care plans based on the resident's current status and needs, which was not done in this case.