F0684

E

Failure to Implement Bowel Management Process for Constipated Residents

Debary, Florida Survey Completed on 02-05-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide treatment and care in accordance with professional standards and the medical director’s bowel management directive for residents experiencing constipation. For Resident #1, who had severe cognitive impairment, was always incontinent of bowel and bladder, and carried a diagnosis of constipation, the bowel movement task record showed no documented bowel movements on multiple non-consecutive days. Specifically, there were no recorded bowel movements on 1/24/26, 1/25/26, 1/26/26 and again on 1/31/26, 2/01/26, and 2/02/26, with no documented evidence that medications were given for relief on either occasion. On 2/2/26, a progress note documented that the resident’s family/POA requested to speak to a supervisor, the resident was described as alert with confusion and refusing dinner, and the POA insisted on calling 911 for altered mental status. A KUB ordered that day showed a non-obstructive bowel gas pattern with abundant fecal burden within the colon.

For Resident #2, who had Parkinson’s disease with dyskinesia and moderate cognitive impairment, the bowel movement task record showed no recorded bowel movements for four consecutive days. There was no documented evidence that medications were given per the bowel management process during this period. In an interview, this resident reported having become constipated and stated that staff “don’t help.” An LPN interviewed about constipation care stated that he would use a red binder at the nurse’s station that contains steps to follow for constipation and that he would listen for bowel sounds and document them in the nurse’s notes. A CNA reported that he notifies the nurse of changes in bowel movements and that there is a standard of three days without a bowel movement that appears on the resident’s electronic chart.

For Resident #4, who was unable to be interviewed, review of the electronic chart for bowel management showed no recorded bowel movements on multiple non-consecutive days, and there was no documented evidence in the MAR or progress notes that PRN medications were given for relief of constipation. The ADON stated that constipation issues are identified via an icon on the electronic chart and that a change in condition form is completed for assessment, but she was not aware of a protocol, instead indicating that residents had standing orders for laxatives and suppositories if they went three days without a bowel movement. A regional nurse consultant later produced a bowel management process document, which stated that residents without a bowel movement for three days should receive Milk of Magnesia and, if ineffective, a bisacodyl suppository, and that the provider should be notified if the resident is in distress, pain, or if interventions are ineffective. Despite this process, the records for the three residents showed missed implementation of these interventions when bowel movements were absent for three days.