Failure to Monitor and Intervene for Prolonged Absence of Bowel Movements
Penalty
Summary
The deficiency involves the facility’s failure to monitor and respond appropriately to a resident’s lack of bowel movements in accordance with physician orders and the resident’s care plan. The resident had diagnoses including diabetes mellitus, major depressive disorder, and a developmental disorder, with an MDS indicating intact cognition, total assistance needed for toileting hygiene, and frequent bowel incontinence. The care plan and physician orders included PRN polyethylene glycol 3350 by mouth every 24 hours for constipation and a PRN bisacodyl 10 mg rectal suppository every 24 hours for constipation, with instructions to call hospice before administering the suppository. The care plan also directed that the hospice aide would document bowel movements and report to the nurse if three or more days passed without a bowel movement. Review of the EMR showed that over a seven‑day period the resident had no documented bowel movement, exceeding the three‑day/72‑hour threshold. During this time, the EMAR documented administration of ondansetron for nausea and multiple administrations of PRN polyethylene glycol 3350 for constipation when no bowel movement had occurred for three days, with subsequent documentation that these interventions were ineffective and the resident still had no bowel movement. Despite the ongoing absence of bowel movements and ineffective PRN laxative use, there was no documentation that a bowel or abdominal assessment was completed in the progress notes from 01/30/26 through 02/04/26. Staff interviews revealed that CNAs were responsible for documenting bowel movements in the EMR and that nurses relied on an EMR dashboard alert that triggered when no bowel movement was documented for three days. The licensed nurse reported that the dashboard only alerted at three days and did not escalate for longer durations, and that she did not pull a full bowel movement record from the EMR. She stated that the provider should be called on day four and bowel assessments documented daily until a bowel movement occurred, but this was not reflected in the resident’s record. The administrative nurse stated she expected charge nurses to monitor bowel movements daily, use the dashboard and printed bowel movement lists, administer PRN constipation medications as ordered, and document bowel assessments and provider notifications, and acknowledged concern that the resident had no bowel movement for seven days. The facility did not have, and did not provide, a policy for bowel monitoring.
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