Failure to Develop and Implement Timely Care Plan for Constipation
Penalty
Summary
A deficiency was identified when the facility failed to develop and implement a comprehensive care plan to address constipation for one resident. The resident was admitted with multiple diagnoses, including a documented diagnosis of constipation, but no care plan addressing constipation was in place until more than two weeks after admission. Despite the facility's policy requiring timely care plan development and the presence of a bowel protocol, the resident experienced multiple episodes without a bowel movement, as documented in the facility's bowel alert lists and medication administration records. The bowel protocol was not initiated until much later, and there was no evidence that interventions were consistently implemented or monitored for effectiveness. The resident's medical records showed repeated documentation of constipation, complaints of discomfort, and requests for stool softeners. Orders for medications such as Senna and Colace were made, but there was inconsistency in their administration and follow-up. The medication administration records did not reflect refusals or consistent use of prescribed laxatives, and there was a lack of documentation regarding the effectiveness of interventions when they were eventually provided. Nursing and medical progress notes indicated ongoing issues with constipation, but the facility did not initiate the bowel protocol in a timely manner, nor did they update the resident's diagnosis list to reflect active constipation. Interviews with facility staff, including LPNs and the DON, revealed that care plans are expected to be initiated at admission and reviewed by registered nurses and the interdisciplinary team. However, in this case, the care plan for constipation was delayed, and the diagnosis was not properly carried over or updated in the resident's records. The resident was eventually discharged and admitted to the hospital with severe sepsis, where imaging revealed significant stool retention and colitis. The deficiency was attributed to the facility's failure to ensure timely and effective care planning and intervention for constipation as required by policy and regulation.