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Based on review of medical records, facility policies and procedures, personnel files, staff interviews and quality data, the facility failed to ensure bowel movements were monitored for one (1) patient ( #1) of the two (2) sampled.

Finding include:

1. Review of the medical record for patient #1, revealed a protocol entitled, "Monitoring of Individuals Bowel Movements", with a revision date of 06/04/11.

Review of the policy revealed that bowel movements would be monitored on a daily basis by the medication nurse and recorded on a bowel movement form. Continued review of the policy revealed, when a nurse
reviews the bowel movement form and concludes that there is no evidence of a bowel movement for three (3) days, nursing interventions would be initiated.

Review of the medical record for patient #1, revealed no evidence of a bowel movement for more than three (3) consecutive days, prior to the patient transferring to the emergency room of an acute facility.

Continued review of the bowel movement record revealed, the number (0)zero recorded bowel movements, without evidence of nursing intervention per the policy and no evidence of physician notification.

Review of the facility's quality data and investigative report with the Quality Director revealed, the facility protocol for the bowel movement monitoring was not followed. As a result of the investigation staff reprimands, resignations and a terminations was initiated. The facility initiated a Plan of Action (POA) in an attempt to correct the identified problem.

Continued review of the POA revealed, that the plan for the patient #1, included evidence that the medication nursing staff failed to reviewed the bowel movement forms.

2. Review of the medical record for patient #2, revealed a protocol entitled, "Monitoring of Individuals Bowel Movements", with a revision date of 06/04/11, revealed no evidence of bowel movement assessment.

Interview on 3/14/13 at 1:00 p.m. the Performance Improvement (PI) nurse, revealed that during monitoring of the medical records on the units for bowel movement policy compliance, documentation of bowel movements were not recorded.