Failure to Monitor Bowel Movements for Resident on Narcotic Pain Medication
Penalty
Summary
The deficiency involves the facility’s failure to monitor bowel movements for a resident at risk of constipation while receiving narcotic pain medication. The resident was admitted with diagnoses including bacteremia, hypertension, cellulitis, type 2 diabetes mellitus, and osteomyelitis, and a quarterly MDS documented that the resident was cognitively intact. Physician orders included oxycodone hydrochloride 5 mg by mouth four times a day for pain, a medication known to potentially cause constipation. Despite this risk, review of the medical record showed no documentation that the resident’s bowel movements were being monitored and no record of the date of the last bowel movement. During an interview, the resident reported it had been 10 days since having a bowel movement and stated they believed they had been given something to help but did not think it was effective. The Administrator confirmed there was no documentation of bowel movement monitoring for this resident. Reference materials reviewed by surveyors, including Medscape and MedlinePlus, indicated that oxycodone may cause constipation and that a medical provider should be contacted if a person has not had a bowel movement in three days. This lack of monitoring and documentation for a resident at risk of constipation formed the basis of the cited deficiency.
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