Failure to Implement Bowel Protocol for Resident With Prolonged Constipation
Penalty
Summary
The deficiency involves the facility’s failure to identify and implement appropriate interventions for a resident who went nine days without a documented bowel movement despite existing bowel management orders and a bowel protocol. The resident had dementia with severely impaired cognition, required maximal assistance with transfers and toileting, and was frequently incontinent of bowel. The care plan identified chronic constipation and directed staff to administer medications as ordered and monitor for signs of constipation, including no bowel movement for two days when administering narcotics. Physician orders included daily Enulose for constipation and PRN Milk of Magnesia. Record review showed the resident had a small bowel movement on 02/02/26 and then no documented bowel movement from 02/03/26 through 02/11/26, with the next medium bowel movement recorded on 02/12/26. The February MAR indicated Enulose was not administered on three days because the resident was sleeping, and the PRN Milk of Magnesia was not administered at all during the month. Progress notes from 02/02/26 through 02/12/26 lacked evidence that any bowel or abdominal assessments were conducted during the nine-day period without a documented bowel movement. Staff interviews revealed that CNAs and CMAs documented incontinence and bowel movements in separate tasks, and the CMA relied on a dashboard that only displayed 24–48 hours of bowel records, with charge nurses responsible for printing a three-day bowel report. Nursing staff reported there was a standing bowel protocol to be initiated when a resident had no bowel movement for three days, and that nurses were responsible for abdominal assessments and documentation in the EMR. The facility’s bowel and bladder management policy required licensed nurses to review bowel reports each shift, assess residents approaching three days without a bowel movement, and follow a stepwise bowel protocol, but there was no documentation that these assessments or protocol steps were implemented for this resident during the nine-day period without a documented bowel movement.
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