Failure to Follow Bowel Protocol and Physician Orders for Eye and Wound Care
Penalty
Summary
The deficiency involves the facility’s failure to follow its bowel care protocol and physician orders for bowel management and eye lubrication, resulting in missed treatments for two residents. For one resident with hypothyroidism, breast cancer, and depression, the care plan identified constipation as a side effect of an antidepressant. The facility’s 2025 bowel care protocol required a stepwise approach to constipation, including administration of Senna after 3 days without a bowel movement, MiraLAX after 4 days, a suppository after 5 days, and an enema after 6 days. The resident’s MAR showed that although Senna and MiraLAX were prescribed, neither was administered during a 6‑day period without a bowel movement from 11/7/25 to 11/13/25, and only a suppository was given on the sixth day. Nursing staff confirmed that suppositories were intended to be used after other bowel interventions failed and that this sequence did not follow the facility’s bowel care protocol, and a CMA reported being unaware of the protocol. The deficiency also includes failures to follow physician orders for eye drops and wound care for another resident with an infected amputation stump, an open wound on the right thigh, acute posthemorrhagic anemia, and an above‑knee amputation. A physician order required lubricant eye drops twice daily and as needed for dry eyes, but the MAR showed the drops were not administered for a 16‑day period, and an LPN/Resident Care Manager stated the order had been transcribed incorrectly and that the resident missed at least 28 doses, placing the resident at risk for discomfort related to dry eyes. Additional physician orders required wound care to the resident’s right leg twice daily, then once each day shift, and daily chest wound care. On specific dates, the TAR reflected a code to hold treatment or see a nurse note, and progress notes documented a care conference or a meeting with social services, with no documentation that the ordered wound care was completed on those days. The LPN involved stated she did not complete the wound care when the resident was in these meetings, and the DNS stated that physician orders were to be followed.
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