| 46 |
BELLA TERRA OF BILLINGS |
275020 |
1807 24TH ST W |
BILLINGS |
MT |
59102 |
2018-06-14 |
684 |
D |
0 |
1 |
JJY911 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility nursing staff failed to provide bowel regimen care for 1 (#66) of 19 sampled residents which resulted in significant discomfort for the resident. Findings include: During an interview on 6/12/18 at 9:05 a.m., resident #66 stated she had constipation problems, no regular bowel movements, and discomfort because of the constipation. Review of resident #66's Significant Change MDS, with an ARD of 5/21/18, showed the resident was cognitively intact. The MDS showed the resident was dependent on staff for toileting and required a two person assist. Review of resident #66's Care Plan, with a review completion date of 6/8/18, showed no documentation that the facility staff had identified a concern with the resident's constipation concerns. Review of the BM Report, for bowel movements, dated 3/22/18 through 6/13/18, showed resident #66 had no documentation of bowel movements from: - 3/22/18 until 3/31/18, nine days without a bowel movement documented, - 4/1/18 until 4/11/18, ten days without a bowel movement documented, - 4/12/18 until 4/20/18, eight days without a bowel movement documented, - 4/22/18 until 4/27/18, five days without a bowel movement documented, and - 4/28/18 until 5/8/18, ten days without a bowel movement documented. Review of resident #66's physician orders, dated 3/1/18 - 3/31/18, showed the resident had an order, with a start date of 3/6/18, for [MEDICATION NAME] solution, 10 grams, one time a day, every other day for constipation. Another order, with a start date of 3/6/18, showed the resident had a decrease in the amount given of [MEDICATION NAME] 10 g/15 ml syrup, give 30 ml every six hours as needed, to giving [MEDICATION NAME] 30 ml every 48 hours as needed. Review of physician orders, dated 4/1/18 - 4/30/18, showed resident #66 had an order for [REDACTED].>- Polyethylene [MEDICATION NAME], 17 grams powder, give by mouth one time a day for constipation. The order date was 1/22/18 and the start date was 2/26/18, over a month from the order date. There was no documentation showing the physician had been made aware of the medication not being given for over a month. - An order, dated 4/23/18 for Tucks pads, to apply to hemorrhoids three times daily as needed; and, - The order for [MEDICATION NAME] 10 g/15 ml syrup, give 30 ml every 48 hours as needed, was changed on 4/23/18 to every day as needed. A review of the facility's Bowel Management Policy, with a revision date of 2/20/17, showed if there was a change in the resident's pattern of bowel movement, the facility would notify the physician and then follow up to ensure the physician's orders [REDACTED]. During an interview on 6/14/18 at 10:15 a.m., staff member B stated that reviewing the bowel documentation for resident #66, showed the resident was improving since the new company took over the facility in (MONTH) (2018). Review of the BM Reports showed from 3/22/18 until 5/8/18, resident #66's bowel regime had no consistency. There were many days between bowel movements. The physician's orders [REDACTED]. There was no documentation showing the physician was aware of resident #66 having pain related to constipation. The care plan showed no documentation that the facility staff were aware resident #66 was having constipation. |
2020-09-01 |