Failure to Follow Bowel Protocol and Physician Orders for Constipation Management
Penalty
Summary
The deficiency involves the facility’s failure to follow physician orders and its own bowel protocol policy for a resident requiring bowel management. The facility’s Bowel Protocol policy, reviewed on 9/15/25, stated that the facility, in coordination with the attending practitioner, would implement standing orders to address a lack of bowel movement. Resident #13 was admitted with multiple diagnoses including hypertensive heart and chronic kidney disease and respiratory failure. The resident’s medication administration record contained standing PRN orders dated 1/22/26 for Senna tablets to be given if there was no bowel movement (BM) in 72 hours, Bisacodyl delayed-release tablets if no BM in 96 hours, a Bisacodyl suppository if there was no BM by 10:00 the day after oral Bisacodyl, and a Fleet enema if there was no result two hours after the suppository, with instructions to call the MD if there was no BM within two hours of the enema. Record review on 3/18/26 at 2:01 PM showed that the resident had a BM on 2/21/26 at 03:56 and then not again until 2/26/26 at 22:39, a gap of over 120 hours. During this period, there was no documentation that any of the ordered bowel management medications were administered between 2/24/26 and 2/26/26, despite the standing orders tied to specific time intervals without a BM. Further review at 2:07 PM on 3/18/26 showed no nursing progress note documentation that the physician had been contacted on 2/25/26 through 2/26/26 regarding the absence of a BM for over 96 hours. In an interview at 2:20 PM on 3/18/26, the Executive Director stated that nursing staff should have contacted the physician after 96 hours without a BM and had not done so.
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