Failure to Follow Bowel Protocol and PRN Constipation Orders
Penalty
Summary
The facility failed to follow its bowel care standing orders and physician constipation orders for two residents who went more than 72 hours without a documented bowel movement (BM). The facility’s standing orders and bowel protocol required administration of a bisacodyl delayed-release tablet after no BM in three consecutive days, followed by a bisacodyl suppository if there were no results within 24 hours, and then a Fleet enema if there were still no results, with provider notification if there was no effect after the enema. For one resident with multiple diagnoses including a left arm fracture and repeated falls, the medical record showed a BM on 1/30/26 and not again until 2/4/26 (about 84 hours later), and another BM on 2/16/26 with no further BM until 2/20/26 (about 96 hours later). This resident had a daily MiraLax order that was administered as prescribed, as well as PRN orders for bisacodyl tablet, bisacodyl suppository, and Fleet enema for constipation, but the bisacodyl tablet, suppository, and enema were not administered during these periods without a BM. Another resident, with multiple diagnoses including cellulitis of the right lower limb and pulmonary fibrosis, had documented BMs on 2/10/26 and then not again until 2/15/26 (over 120 hours later), and on 2/18/26 with no further BM until 2/22/26 (over 96 hours later). This resident had PRN orders for bisacodyl delayed-release tablets, bisacodyl suppositories, and Fleet enemas for constipation, to be used sequentially if there was no BM in three consecutive days and no response within 24 hours to each intervention. The record showed only one dose of bisacodyl tablet given on 2/15/26, with no administration of the ordered bisacodyl suppository or Fleet enema during the extended periods without a BM. On 2/24/26 at 10:08 AM, the DNS confirmed that both residents had no documented BM for over 72 hours without nursing intervention using the prescribed medications, despite the standing orders and physician orders in place.
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