Failure to Follow Bowel Management Protocol and Provider Orders
Penalty
Summary
The deficiency involves the facility’s failure to follow its bowel management protocol and provider orders for a resident with documented constipation risk. The facility’s undated "Management of Constipation" policy required daily documentation of bowel patterns and initiation of a bowel protocol if no bowel movement (BM) occurred in 48 hours, including administration of Milk of Magnesia (MOM) on the morning of the third day, a digital rectal exam 8–10 hours later if still no BM, a rectal suppository if soft stool was present, and provider notification for enema orders if there was no result within four hours of the suppository. Admission documentation showed the resident’s last BM was on 12/28/2025, and the electronic health record contained no documented BM for the entire facility stay. Provider orders dated 12/29/2025 mirrored the bowel protocol steps. Review of the eMAR showed the resident received MOM on 12/31/2025, and staff later reported an additional MOM dose on 1/2/2026, but there was no documentation of a digital rectal exam, rectal suppository, enema, or provider notification despite the continued absence of a BM. Interviews with CNAs and LPNs confirmed that CNAs were responsible for documenting BMs in the electronic system and notifying nurses if a resident had no BM in three days, and that nurses were expected to administer MOM, then a suppository, and then contact the provider for an enema if needed. The Resident Care Manager and the Director of Nursing acknowledged that the resident did not have a BM during the stay, that no digital exam or further constipation interventions were documented after MOM administration, and that the facility’s bowel protocol and provider orders were not followed. The resident’s daughter reported that the resident was in pain, had no BM during the facility stay, and was later found to have a fecal impaction requiring removal at the hospital, with further health complications noted there.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.