F0684

D

Failure to Implement Bowel Protocol and Respond to Resident’s Constipation Complaints

Kittanning, Pennsylvania Survey Completed on 02-25-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to follow its bowel routine policy and physician orders to provide appropriate treatment and care for a resident with constipation. The facility’s Bowel Routine Policy required that each resident have routine bowel elimination, with Milk of Magnesia given if no bowel movement occurred in 72 hours, followed by Dulcolax suppository, then a Fleet enema, and physician notification if these were ineffective. The resident was admitted with diagnoses including constipation, high blood pressure, and cervicalgia, and admission documentation and the discharge transition packet later confirmed the last bowel movement was on 2/4/26. A progress note on 2/12/26 documented that the resident’s last bowel movement had been on 2/5/26, and the clinical record for that date did not show any bowel movement.

On 2/12/26, physician orders were in place for a bowel regimen: Milk of Magnesia 30 ml by mouth as needed if no bowel movement in 48 hours, Dulcolax suppository if Milk of Magnesia was ineffective, and a Fleet enema if there was still no bowel movement after the suppository. Review of the February 2026 MAR showed no evidence that these medications were administered as ordered on 2/12/26. Staff interviews indicated that for newly admitted residents, last bowel movement is assessed upon admission, bowel protocol medications are automatically put in place, and staff can review discharge paperwork to determine the last bowel movement. An LPN stated that if a resident has not had a bowel movement in three days, the bowel protocol should be initiated, and that if a resident has a change in condition, they must be assessed, vitals obtained, and the physician notified.

Multiple staff accounts and the resident’s own statements described repeated requests for help and for transfer to the hospital due to abdominal pain and lack of bowel movement, without appropriate nursing assessment or timely response. A nurse aide reported that the resident rang the call bell requesting to see the RN supervisor to go to the emergency room, that the RN supervisor was notified, and that the RN supervisor stated she had done his paperwork and was not going back, and did not go to the resident’s room. An LPN reported overhearing the resident say he wanted to go to the hospital and that he had been asking all day, complaining of not having a bowel movement in 7–10 days, and that the RN supervisor commented she did his paperwork and did not know what else she could do. The resident ultimately called 911 himself from his room. The hospital discharge summary documented that he was hospitalized for rectal fecal impaction and severe constipation requiring oral laxatives, disimpaction, and soap suds enema. The Nursing Home Administrator confirmed that the facility failed to provide care and services needed for the resident to attain or maintain the highest practicable well-being.