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Scope: Isolated
Severity: Immediate jeopardy to resident health or safety
Citation date: September 8, 2023
Corrected date: October 11, 2023
Citation Details None | Plan of Correction: ApprovedOctober 18, 2023 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 1. Resident #1 was discharged to the hospital on [DATE] and expired in the hospital on ,[DATE]/ 23. Primary Physician NP#1 was educated regarding documenting on Resident #1's condition or whether they had an assessment and documenting the evidence as to why the x-ray and labs were ordered. Resident's #1 direct care nursing staff were educated regarding the Bowel Management policy, bowel movement documentation, signs and symptoms of constipation, monitoring clinical alerts on the electronic medical record (EMR), and monitoring CNA Point of Care to ensure any lack of bowel movements or missing documentation will be documented and to reported to the Residents' Physicians and will be addressed accordingly. There were 15 CNAs identified that did not document bowel movements in the EMR for Resident # 1. 2 of these identified CNAs are no longer employed at the facility. The remaining 13 CNAs were provided with education on documenting bowel movements in the EMR and completed a competency on the same. 2. All residents at risk of constipation have the potential to be impacted. All resident at risk of constipation care plans were reviewed and revised as appropriate by an RN. An audit of all residents bowel movement documentation and clinical alerts was conducted to ensure any lack of bowel movements or missing documentation will be documented and reported to the Residents' Physicians and will be addressed accordingly. All newly admitted residents will be reviewed for the potential risk for constipation upon admission by a Licensed Nursing Staff to ensure an appropriate plan of care and proper intervention are in place. All resident at risk of constipation care plans were reviewed by the RD and identified residents' care plans were revised as necessary with nutritional interventions. All newly admitted residents will be assessed by the RD for potential nutritional interventions as it relates to their potential for constipation. 3. The Bowel Protocol for Constipation policy was reviewed and revised, to include that physician orders [REDACTED]. A Bowel Disorders Clinical Protocol policy was implemented that includes Assessment and Recognition of Bowel (Lower Gastrointestinal Tract) Disorders, Cause Identification, Treatment and Management, and Monitoring and Follow Up by staff and physician. The facility utilized the services of an outside consultant Registered Nurse to develop lesson plans and assist with education. The content of the new Bowel Disorders Clinical Protocol policy has been included in the lesson plans utilized to educate all licensed and unlicensed nursing staff, occupational therapy staff, and RD staff. The content of the policy includes the signs for constipation and presence of fecal impaction. Education of bowel movement documentation and signs and symptoms of constipation was provided to all CNA staff, occupational therapy staff, and RD staff. The content of the education includes the signs for constipation and presence of fecal impaction. Education on bowel movement documentation, signs and symptoms of constipation, presence of fecal impaction, monitoring clinical alerts on the EMR, and monitoring CNA Point of Care documentation was provided to all licensed nursing staff. Education will be provided to Unit Managers, Nursing Administration (DNS, ADNS, ICP Nurse, Wound Care Nurse), RN Supervisors, physicians, and physician extenders to include sentinel event notification in the High Acute Status MD group chat. The education on the High Acute Status MD Group Chat was provided by the Administrator. The Unit Manager/Designee will review all EMR Dashboard Clinical Alerts at the end of the shift/beginning of the next shift to ensure documentation is completed by CNAs daily. The Unit Manager/designee will identify CNA/s if there is missing bowel movement documentation. Any identified CNA/s will be provided with re-education and progressive disciplinary action as needed. An audit tool was created (Supervision Bowel Audit) to monitor residents who have alerted for no bowel movements in 48 hours. Residents who have no bowel movement recorded in the EMR triggers a clinical alert after 48 hours on the EMR Dashboard under Clinical Alerts. This audit will be conducted nightly by the RN Supervisor/Designee. The result of the audit will be reported to DNS/designee. The High Alert Bowel monitoring tool has been replaced with this audit tool. The RN will ensure an assessment was completed or conduct an assessment if necessary for those residents who have alerted on the EMR for no bowel movement in 48 hours to ensure appropriate bowel protocols are in place and notify the physician/physician extender. The RN will ensure the resident is placed on the 24-hour report to be discussed at the interdisciplinary Morning Report meeting. 4. DON/Designee will audit clinical alerts and residents BM documentation weekly X4 then monthly X3 to ensure conducted to ensure any lack of bowel movements or missing documentation will be documented and to reported to the Residents' Physicians and will be addressed accordingly by physician assessment and interventions and to be followed up for effectiveness of interventions. The result of all audits will be reported to QAPI committee monthly for review and feedback. 5. Responsible Party: Director of Nursing |