Failure to Prevent and Treat Constipation Resulting in Harm
Penalty
Summary
The facility failed to implement preventative measures, promptly assess, and treat constipation for a resident with dementia, resulting in actual harm. The resident had a documented history of constipation and was prescribed both scheduled and PRN medications for bowel management. Despite this, documentation showed prolonged periods without bowel movements, including a six-day and a ten-day interval with minimal or no bowel movements. During these periods, there was no evidence that PRN medications for constipation were administered, even though they were available and ordered. Nursing and CNA documentation indicated that the resident experienced increasing abdominal pain, decreased appetite, and eventually vomiting. Nursing staff noted the absence of regular bowel movements and administered a rectal suppository only after the resident began to show significant symptoms. The resident's condition deteriorated further, with continued abdominal pain, lethargy, fever, and abnormal vital signs. The on-call physician's assistant was contacted, and an abdominal X-ray was ordered, but the resident's status continued to decline, leading to transfer to the hospital. At the hospital, the resident was diagnosed with a small bowel obstruction, acute kidney injury, and sepsis. The hospital course included non-operative management due to the resident's advanced age and comorbidities, and the plan was shifted to comfort-focused care. The facility's own staff and leadership acknowledged issues with documentation and communication regarding bowel management, and the lack of timely intervention and follow-through on bowel protocols contributed to the resident's decline and subsequent hospitalization.