Failure to Follow Bowel Management Orders and Protocol
Penalty
Summary
The deficiency involves the facility’s failure to follow physician orders and its own bowel and bladder protocol for a resident with constipation and multiple diagnoses, including bipolar schizoaffective disorder. The facility’s protocol dated 7/8/20 directed staff to offer prune juice or Milk of Magnesia 24–48 hours after the last bowel movement, Bisacodyl 5 mg PO/PR at 48–72 hours, and to review the resident’s condition with a medical provider at 72 hours if no bowel movement occurred. Physician orders for this resident included Milk of Magnesia 30 ml by mouth, with one repeat dose allowed in 24 hours as needed for constipation, and one-time Bisacodyl 5 mg EC tablet orders on several dates. Record review showed that after a documented bowel movement on 12/14/25, the resident did not have another recorded bowel movement until 12/23/25, a gap of over 192 hours, with no documentation that any ordered constipation medications were administered between 12/15/25 and 12/23/25. After a bowel movement on 12/30/25, the next was not documented until 1/6/26, during which time only one dose of Bisacodyl 5 mg EC tablet was given on 1/5/26, with no other constipation medications documented from 12/31/25 to 1/4/26. Following a bowel movement on 1/6/26, the next was not documented until 1/12/26, with only one Bisacodyl 5 mg EC tablet administered on 1/12/26 and no documentation of constipation medications from 1/7/26 to 1/11/26. The Administrator confirmed that the resident should have received the ordered bowel management medications and had not.
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