Failure to Timely Develop and Implement Bowel Management Care Plans
Penalty
Summary
The deficiency involves the facility’s failure to timely develop and implement comprehensive, person-centered care plans with measurable objectives and time frames for a resident experiencing bowel issues. The facility’s policy dated October 2022 required a comprehensive care plan for each resident based on the comprehensive assessment. The resident, who had decision-making capacity, was receiving daily laxative and stool softener therapy via G-tube but had no care plan addressing constipation, despite these ongoing bowel management medications. On one date, nursing progress notes documented loose stools and a physician’s order to discontinue docusate sodium, hold Geri-Kot, and start Lactobacillus. Subsequent orders confirmed discontinuation of the stool softener, holding the laxative, and initiation of probiotics for bowel management. The resident’s care plan for diarrhea and loose stools was not initiated until seven days after the first documented episode of loose stools, and the care plan interventions to monitor, document, and report signs and symptoms of dehydration were not implemented, as the medical record lacked evidence of such monitoring. Nursing notes later documented continued diarrhea, abdominal assessment findings, nausea, and a new order for loperamide for loose stools or diarrhea, followed by transfer to an acute care hospital ICU for abnormal vital signs. During interviews, the MDS Coordinator confirmed that the resident did not have a constipation care plan despite daily laxative and stool softener use and that the diarrhea/loose stool care plan was not initiated until several days after the first episode, stating it should have been initiated as soon as the episode occurred. The IP also confirmed that the loose stools were initially treated as a single episode and that the care plan was only initiated when a change of condition was reported and documented. The report states these failures had the potential risk of not providing appropriate, consistent, and individualized care to the resident.
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