Failure to Manage and Report Resident Diarrhea and Follow PRN Medication Orders
Penalty
Summary
The deficiency involves the facility’s failure to provide care and services according to professional standards and physician orders for a resident with acute myeloblastic leukemia, severe sepsis, acute kidney failure, and malnutrition. The resident, who had a BIMS score indicating moderately impaired cognition, reported ongoing diarrhea with up to three large loose stools in 24 hours and stated feeling punished due to staff frustration with frequent bathroom use. The physician’s orders included Colace 100 mg, two capsules by mouth twice daily, to be held for episodes of loose stool, and loperamide 2 mg by mouth as needed after each loose stool, with a maximum of 8 mg in 24 hours. Review of the MAR and progress notes for March showed that the 9 a.m. Colace dose was held for loose stools on multiple dates, and both 9 a.m. and 5 p.m. doses were held on additional dates, yet loperamide was not administered on any of those occasions. The resident also reported refusing Colace because it worsened already loose stools. The facility also failed to recognize and report the resident’s multiple episodes of diarrhea as a change in condition to the physician. The DON confirmed there was no documentation that the physician was informed of the repeated loose stools between early February and late March, despite acknowledging that multiple episodes of diarrhea represent a change of condition requiring prompt reporting. RN 1 stated the resident continued to have loose stools and that Colace and Ensure were on hold, but there was no care plan in place for the diarrhea. LVN 1 stated that multiple diarrhea episodes require a change of condition report and that he would not have known about the loose stools unless they were documented in the 24-hour report. The facility’s policy on change in a resident’s condition or status indicated that the nurse should notify the attending physician when a resident refuses a medication two or more consecutive times. Social services notes documented that the resident felt mistreated by a CNA during care, particularly in response to several episodes of diarrhea.
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