Failure to Monitor and Treat Constipation Due to Lack of Bowel Management Protocol
Penalty
Summary
The facility failed to monitor bowel movements and assess for and provide treatment for constipation in accordance with professional standards of practice for two residents. One resident, admitted with a healing thigh fracture, repeated falls, and heart failure, had not had a bowel movement for more than ten days. Despite notifying staff, the resident did not receive any medications for constipation until several days after the issue began. Documentation showed incomplete or missing records of bowel movements, and there was no evidence of bowel assessments being completed during the period of constipation. Medication orders for bowel care were present but lacked clear instructions on when to initiate treatment or the sequence of medications to be used. Another resident, admitted with a fractured vertebra, enlarged heart, and fecal abnormalities, also experienced a lack of bowel movements for five consecutive days. Despite having standing orders for bowel medications, there was no documentation that any medication was administered during this period. Staff interviews revealed inconsistencies in the process for monitoring and responding to residents' bowel patterns. Nursing assistants documented bowel movements but did not communicate directly with nurses when residents had not had a bowel movement. Registered nurses relied on electronic alerts and a clinical dashboard to monitor bowel patterns, but there was confusion regarding the protocol and documentation of assessments. A review of the facility's standing orders and protocols revealed that there was no clearly defined or accessible bowel management protocol indicating which medications to use or when to initiate them. The administrator confirmed that the facility lacked a defined process or protocol for bowel management. This lack of clear guidance and consistent monitoring led to delays in assessment and treatment for constipation for the affected residents.