Failure to Initiate and Document Bowel Interventions per Physician Orders
Penalty
Summary
The facility failed to initiate and document bowel interventions as ordered for five residents who were reviewed for quality of care. According to the facility's bowel protocol and physician orders, licensed nurses were required to monitor bowel movements daily and administer specific interventions if a resident had not had a bowel movement for three days. These interventions included administering milk of magnesia on day four, followed by a stimulant laxative suppository or oral tablet if there was no result, then an enema if still no result, and notifying the physician if all interventions failed. However, record reviews showed that these steps were not followed for multiple residents. For example, one resident went approximately 139 hours without a bowel movement, and another went about 228 hours, with no documentation of any bowel interventions during these periods. Another resident experienced a gap of 110 hours between bowel movements, again with no evidence of interventions being administered as per protocol. Additionally, a resident reported experiencing constipation and hard stools, with records confirming that staff did not administer the required interventions on the fourth day without a bowel movement. In another case, a resident went seven days without a bowel movement, and although some interventions were attempted, staff failed to follow through with the full protocol as ordered. Interviews with staff, including the Resident Care Manager, LPN, and DON, confirmed that the bowel management protocol was not consistently followed or documented. Staff acknowledged that alerts should have triggered interventions and that the protocol should have been initiated and documented per policy. However, they were unable to provide documentation of successful bowel interventions for the affected residents during the periods in question.