| 20 |
GUAM MEMORIAL HOSPITAL AUTHORITY |
655000 |
499 NORTH SABANA DRIVE |
BARRIGADA |
GU |
96913 |
2017-08-24 |
309 |
D |
0 |
1 |
10C511 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, staff interview, and facility policy Bowel Management dated as revised 12/15 review, the facility failed to ensure that a bowel protocol was implemented for 1 Resident (R) 4 out of a survey sample of 8. Findings include: Per clinical record review, R4 was admitted to the facility on [DATE], with a [DIAGNOSES REDACTED]. Per clinical record review, the Nurse's Notes dated 4/21/17 noted that the resident had a bowel movement (BM) on 4/18/17. A care plan, dated 4/25/17, identified the resident would be assisted to the bathroom or use a bedpan when the resident feels the urge to have a BM. There was no indication that the resident was on a bowel protocol. The admission Minimum Data Set (MDS) assessment for R4 dated 4/28/17, Section C for cognition, identified the resident's Brief Interview Mental Status (BIMS) score was 13 which indicated that the resident was cognitively intact. Section H, for Bowel and Bladder, identified that the resident was always incontinent of bowel. Review of the clinical record for R4 included physician orders [REDACTED]. A physician's orders [REDACTED]. A physician's orders [REDACTED]. [MEDICATION NAME] 10 mg suppository, to be administered rectally daily, as needed if no BM for 3 days. The Medication Administration Record [REDACTED]. From 5/7/17 through 10/17 and from 5/12/17 through 5/14/17 that the resident did not have a BM during this time period. There was no evidence on the MAR indicated [REDACTED]. There were no Nurse's Notes to indicate that the resident refused bowel care on these dates. On the MAR indicated [REDACTED]. There was no documented evidence, on the MAR, or in the Nurse's Notes that the resident was administered laxatives on these dates, per physician order. There were no Nurse's Notes notes to indicate that the resident refused bowel care on these dates. The MAR indicated [REDACTED]. There was no documented evidence, on the MAR indicated [REDACTED]. There were no Nurse's Notes to indicate that the resident refused bowel care on these dates. The MAR indicated [REDACTED]. There was no documented evidence, on the MAR, or in the Nurse's Notes that the resident was administered laxatives on these dates, per physician order. There were no Nurse's Notes to indicate that the resident refused bowel care on these dates. An interview was conducted on 8/22/17 at 1:35 p.m. with Staff Member 9. Per Staff Member 9, the resident has a history of refusing to take laxatives for bowel care. Staff Member 9 said that R4's refusals should be in the Nurse's Notes. The facility policy entitled, Bowel Management dated as revised 12/15 noted, .To serve as a guideline to assist nursing staff to ensure the residents in the facility do not have complications with their bowel functions .Treatment will be initiated per the following protocol .(Non-[MEDICAL CONDITION] (end stage [MEDICAL CONDITION]) .After 48 hours without a BM, the medication nurse will give Polyethylene [MEDICATION NAME] 3350, 17 g (grams) po ( administered by mouth) in 8oz (ounces) water Daily (max 7 days) .After seventy-two (72) hours, if there is no BM, the medication nurse will administer [MEDICATION NAME] 10 mg suppository every 24 hours prn (as needed) .Residents with End Stage [MEDICAL CONDITIONS] will have the following bowel protocol .After 48 hours without a BM, the medication nurse will administer [MEDICATION NAME] 30 ml by mouth .After seventy-two (72) hours, if there is no BM, the medication nurse will administer [MEDICATION NAME] 10mg every 24 hours prn .If 4 days without a BM call attending physician . |
2020-09-01 |