| 11226 |
ANSTED CENTER |
515133 |
106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400 |
ANSTED |
WV |
25812 |
2009-09-24 |
309 |
D |
1 |
0 |
0T3Z11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to assure staff routinely monitored the bowel habits of residents and monitored / recorded interventions that were initiated in accordance with the physician's standing orders when a resident was experiencing problems with constipation. According to the medical record, Resident #58 went five (5) days without a bowel movement before interventions were initiated in accordance with the standing orders. Resident #31 went four (4) days without a bowel movement, and the physician's standing orders were not initiated until Day 5, contrary to the established bowel protocol. The bowel protocol was not followed for two (2) of nine (9) sampled residents. Resident identifiers: #58 and #31. Facility census: 57. Findings include: a) Resident #58 Record review revealed Resident #58 had experienced problems with constipation. In May 2009, the resident's bowel records indicated there was no bowel movements from 05/15/09 through 05/19/09. The facility's bowel protocol was requested for review. The director of nursing (DON) provided a "standing orders template" and indicated the interventions listed under the section titled "constipation" were what they do if there is not a bowel movement. According to these orders for constipation, if there is no bowel movement in three (3) days, staff is to give the resident one (1) dose of 30 cc Milk of Magnesia or [MEDICATION NAME] tablets. If there is still no bowel movement on Day 4, staff is to give the resident a [MEDICATION NAME] rectal suppository PRN x 1. If there is no bowel movement on Day 5, staff is to give the resident a Fleets enema. If there are no results from the enema, staff is to call the doctor for further orders. These standing orders were not followed for Resident #58. According to the resident's nurse aide flow sheet, she did not have a bowel movement on 05/15/09, 05/16/09, 05/17/09, 05/18/09, and 05/19/09. On Day 6, staff administered a [MEDICATION NAME] rectal suppository. The facility did not follow the standing physician orders [REDACTED]. The DON, when interviewed on 09/22/09 at 3:00 p.m., reported the information recorded on the nurse aide flow sheet in the resident's medical record was not used to monitor the resident's bowel elimination patterns. Instead, the nurses used information recorded on a separate bowel sheet to guide the administration of the standing orders for constipation. She confirmed these bowel sheets were not part of the resident's medical record, and they did not keep these sheets for more than a couple of months, after which they threw them away. (The facility did not have bowel sheets for the time frame being reviewed for this resident.) The DON did confirm that, based on the data available in the medical record, there was no evidence the resident had a bowel movement on the days in question. The DON also confirmed the standing orders were not followed as written. b) Resident #31 Record review revealed the resident's September 2009 nurse aide flow sheet was not complete related to her bowel elimination. (See citation at F514.) A separate bowel sheet (not maintained on the resident's medical record) revealed she had gone four (4) days without a bowel movement, and the physician's standing orders were not initiated until Day 5. As of the date of this review (09/24/09), Resident #31's record indicated her last bowel movement occurred on 09/19/09. She received Milk of Magnesia on 09/22/09, which was three (3) days after her last bowel movement. She still did not have a bowel movement and on the next day (09/23/09), she was given Senakot four (4) tablets. The DON, when questioned about the bowel movements for this resident on 09/24/09 at 4:00 p.m., verified the facility's standing orders had not been properly implemented and there was no documentation to explain why these orders were not followed. According to the DON, the resident should have received a rectal suppository on Day 4 and a Fleets enema on Day 5. According to the medical record, the resident had no bowel movement for four (4) consecutive days and was on Day 5 without a bowel movement when this surveyor identified this issue. . |
2014-07-01 |