Failure to Follow Bowel Management Protocol and Timely Assessment
Penalty
Summary
The facility failed to ensure accurate documentation and appropriate follow-up for a resident with a known history of constipation who did not have a bowel movement for more than three days. Despite the resident being at risk for constipation due to decreased mobility and frequent pain medication use, there was no documentation that the bowel protocol was followed when the resident went six days without a bowel movement. The resident's care plan included interventions such as administering medications per physician orders and monitoring for complications of constipation, but the medical record showed that the resident frequently refused prescribed bowel medications, and there was no evidence of additional interventions or education regarding these refusals. Certified Nursing Assistants documented the absence of bowel movements, and the facility's electronic medical record system triggered alerts for no bowel movement over several days. However, there was no documentation that the physician or nurse practitioner was notified as required by facility policy, nor was there evidence of a timely nursing assessment, such as checking bowel sounds or providing additional interventions. Staff interviews confirmed that the process for tracking and responding to residents without bowel movements was not consistently followed, and there was confusion among staff regarding whether the resident had been placed on the no bowel movement list and whether appropriate notifications had occurred. The resident experienced a decline in condition, including increased pain, drooling, and greenish phlegm, which led to a nurse practitioner evaluation and subsequent hospital transfer. Hospital records did not indicate a bowel blockage, but the facility's failure to document bowel movements accurately, follow the bowel management protocol, and ensure timely assessment and notification contributed to the deficiency identified during the survey.