Failure to Treat Resident Constipation per Physician Orders and Bowel Monitoring
Penalty
Summary
The deficiency involves the facility’s failure to provide treatment and care for constipation as ordered by the physician and in accordance with the resident’s comprehensive assessment and care needs. A cognitively intact male resident with diabetes, bilateral above-knee amputations, heart failure, and constipation had an admission MDS showing he required partial assistance with toileting and a care plan noting self-care deficit and fall risk. The bowel continence flow sheet showed no bowel movement documented for this resident from 03/17/26 through 03/24/26, despite an existing PRN order dated 03/14/26 for a Dulcolax (bisacodyl) 10 mg rectal suppository every 12 hours as needed for constipation if no bowel movement occurred in 48 hours. The MAR reflected the suppository was administered only on 03/14/26 and again on 03/24/26, indicating the order was not used to address the multi-day absence of bowel movements. On 03/24/26 in the morning, the resident reported needing something for constipation, described abdominal discomfort, and believed his last bowel movement had been the previous week. He requested an enema from an RN, who stated he would need to contact the physician because there was only an order for a suppository. The RN contacted the physician, who instructed him to administer the suppository first and call back if there were no results; the RN then administered the suppository around 11:15 AM, after which the resident had a large bowel movement. The RN stated he was unaware the resident had not had a bowel movement since the prior week and indicated CNAs were responsible for documenting bowel movements and notifying the nurse if there was no bowel movement for more than two days. A CNA reported the resident had not complained to her about not having a bowel movement and that CNAs typically did not review bowel patterns in the Kardex, believing the nurse was notified by the computer. The DON stated residents should not go more than three days without a bowel movement and that the system was designed to alert nurses if no bowel movement was documented in two days, but she did not know whether the alert was missed or failed to activate, and also stated there was no specific facility policy addressing constipation.
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