Failure to Monitor and Treat Constipation per Bowel Protocol
Penalty
Summary
Surveyors identified a deficiency related to the facility’s failure to monitor and respond to a resident’s lack of bowel movements in accordance with physician orders, the care plan, and the facility’s constipation management policy. The resident had diagnoses including anxiety, depressive disorder, and drug-induced dyskinesia, and MDS assessments showed intact cognition and that the resident was always continent of bowel without constipation. The care plan documented that the resident was on an antidepressant and directed staff to monitor for side effects, including constipation. Physician orders included following the facility’s bowel routine protocol and PRN orders for prune juice, Milk of Magnesia, and Fleet enemas for constipation. Review of the EMR task records showed that between 02/02/26 and 02/08/26, the resident went six consecutive days without a documented bowel movement or any constipation treatment or assessment. There were no progress notes documenting any assessment or intervention for constipation during this period, despite the facility’s constipation management policy directing that if no bowel movement occurred in three days, Milk of Magnesia should be given, followed by escalating interventions and provider notification if there were no results. Staff interviews confirmed that nurses were expected to monitor bowel movements, receive alerts when a resident went three days without a bowel movement, assess the resident, document the assessment, and follow the standing bowel protocol, which did not occur for this resident during the identified timeframe.
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