Failure to Monitor and Implement Bowel Protocol for Constipation
Penalty
Summary
The deficiency involves the facility’s failure to monitor and document a resident’s bowel movements and to implement its bowel movement protocol when the resident did not have a bowel movement. The resident had multiple diagnoses including type 1 diabetes, epilepsy, history of myocardial infarction, Lewy body dementia with progressive cognitive decline, constipation, kidney disease stage three, and sepsis, and was cognitively impaired and nonverbal. The resident required supervision for eating, moderate assistance for bed mobility, and was dependent for toileting and transfers. The care plan identified increased nutrition and hydration needs and included monitoring for signs and symptoms of dehydration, monitoring labs and weights, and reporting refusals to eat or swallowing difficulties. Physician orders included a consistent carbohydrate, mechanical soft diet, a PRN Dulcolax suppository for constipation, and a nutritional supplement. Additional PRN laxative and stool softener orders (MiraLax, Colace, Senna) had been discontinued. From early to mid-February, the Medication Administration Record showed no administration of constipation treatments, and CNA bowel movement documentation and progress notes were silent for any bowel movements during the specified period. The NP’s visit note documented a soft abdomen with positive bowel sounds and no acute distress, but there was no documentation of bowel movement status. The RN confirmed that the electronic health record contained no bowel movement documentation after a certain date, that staff were expected to chart bowel movements daily, and that the electronic system should have triggered an alert for assessment and PRN laxative use, which did not occur. The RN also verified that the physician was not notified of the lack of bowel movements. The Administrator confirmed that the bowel movement protocol, which requires bowel movements to be documented every shift and directs staff to consider PRN treatment or physician notification after three consecutive days without a bowel movement, was not implemented, and that daily bowel movement charting and PRN laxative administration after three days did not occur. The NP stated she was not notified that the resident was not having bowel movements.
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