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Based on document review, staff interviews, and review of hospital policies, the hospital's administrative staff failed to ensure the nursing staff assessed and documented the patient's last bowel movement for 1 of 8 reviewed patient medical records (Patient #1). Failure to regularly assess when the patient last had a bowel movement resulted in the nursing staff failing to identify Patient #1 had potentially gone more than 10 days without having a bowel movement, which could potentially result in patient discomfort, pain, and potentially result in rupture of the bowels. The hospital's administrative staff identified a current census of 24 inpatients at the beginning of the survey.

Findings include:

1. Review of the policy "Assessment and Reassessment of Patients," effective 4/2021, revealed in part, "All patients receiving care or treatment at the Hospital are assessed by qualified professionals ... Patient assessment, at a minimum, considers physical, psychological ... within eight hours of admission ... Reassessment is a documented description of the patient's response/status ... documented approximately every twelve hours and when the patient's needs/condition warrants."

2. Review of Patient #1's medical record revealed:

a. The hospital staff admitted Patient #1 on 12/7/21 at 5:30 PM, following Patient #1 previously undergoing lower back surgery, and Patient #1 developing a surgical site wound infection, which required nursing care and antibiotics to help heal the surgical site wound.

b. Registered Nurse (RN) A and RN B completed Patient #1's initial nursing assessment on 12/7/21 at 6:01 PM. RN A and RN B documented that Patient #1's abdomen was soft, non-distended, and Patient #1 had active bowel sounds (findings that indicate Patient #1's bowels functioned normally and did not indicate Patient #1 was constipated).

c. Patient #1's Medication Administration Record revealed that the nursing staff administered Patient #1 a stool softener and laxative every day.

d. The nursing documentation on 12/8/21 (1 day following Patient #1's admission to the hospital) revealed the nursing staff documented that Patient #1's abdomen was soft, non-distended, and Patient #1 had active bowel sounds. However, the nursing documentation lacked information on when Patient #1 had their last bowel movement.

e. The nursing documentation on 12/9/21 (2 days following Patient #1's admission to the hospital) revealed the nursing staff documented that Patient #1's abdomen was soft, non-distended, and Patient #1 had active bowel sounds. However, the nursing documentation lacked information on when Patient #1 had their last bowel movement.

f. The nursing documentation on 12/10/21 (3 days following Patient #1's admission to the hospital) revealed the nursing staff documented that Patient #1's abdomen was soft, non-distended, and Patient #1 had active bowel sounds. However, the nursing documentation lacked information on when Patient #1 had their last bowel movement.

g. The nursing documentation on 12/11/21 (4 days following Patient #1's admission to the hospital) revealed the nursing staff documented that Patient #1's abdomen was soft, non-distended, and Patient #1 had active bowel sounds. However, the nursing documentation lacked information on when Patient #1 had their last bowel movement.

h. The nursing documentation on 12/12/21 (5 days following Patient #1's admission to the hospital) revealed the nursing staff documented that Patient #1's abdomen was soft, non-distended, and Patient #1 had active bowel sounds. However, the nursing documentation lacked information on when Patient #1 had their last bowel movement.

i. The nursing documentation on 12/13/21 (6 days following Patient #1's admission to the hospital) revealed the nursing staff documented that Patient #1's abdomen was soft, non-distended, and Patient #1 had active bowel sounds. However, the nursing documentation lacked information on when Patient #1 had their last bowel movement.

j. The nursing documentation on 12/14/21 (7 days following Patient #1's admission to the hospital) revealed the nursing staff documented that Patient #1's abdomen was soft, non-distended, and Patient #1 had active bowel sounds. However, the nursing documentation lacked information on when Patient #1 had their last bowel movement.

k. The nursing documentation on 12/15/21 (8 days following Patient #1's admission to the hospital) revealed the nursing staff documented that Patient #1's abdomen was soft, non-distended, and Patient #1 had active bowel sounds. However, the nursing documentation lacked information on when Patient #1 had their last bowel movement.

l. The nursing documentation on 12/16/21 (9 days following Patient #1's admission to the hospital) revealed the nursing staff documented that Patient #1's abdomen was soft, non-distended, and Patient #1 had active bowel sounds. However, the nursing documentation lacked information on when Patient #1 had their last bowel movement.

m. The nursing documentation on 12/17/21 (10 days following Patient #1's admission to the hospital) revealed the nursing staff documented Patient #1's last bowel movement was on 12/17/21. However, Dietician C, on the same day, documented that Patient #1 did not have a bowel movement since Patient #1's admission to the hospital 10 days prior.

n. On 12/19/21, (12 days following Patient #1's admission to the hospital) Physician D ordered the hospital staff to obtain an x-ray of Patient #1's abdomen to evaluate Patient #1's complaints of abdominal pain. The radiologist interpreted the x-ray to indicate Patient #1 had a large amount of feces in Patient #1's rectum, which could cause Patient #1 to have constipation requiring medical assistance to relieve (a fecal impaction).

o. On 12/19/21, Physician D ordered the nursing staff to administer a soap suds enema (when the nursing staff add a specific soap to the enema solution to stimulate the body's natural mechanisms for expelling feces) to Patient #1. RN F administered the soap suds enema to Patient #1.

p. On 12/20/21 (13 days following Patient #1's admission to the hospital), ARNP E (Advanced Registered Nurse Practitioner, a nurse with advanced training in the diagnosis and treatment of patients) ordered the hospital staff to obtain an x-ray of Patient #1's abdomen to evaluate Patient #1's constipation. The radiologist interpreted the x-ray to indicate Patient #1 did not have constipation.



2. During an interview on 2/9/22 at 12:51 PM, RN G indicated they would inform a provider if a patient did not have a bowel movement for 2 or more days. RN G recalled Patient #1 had not had a bowel movement for a while, but did not recall if they notified the provider about Patient #1 not having a bowel movement.

3. During an interview on 2/9/22 at 1:40 PM, RN I revealed they would inform a provider if a patient did not have a bowel movement for 2 or more days. RN I recalled Patient #1 had not had a bowel movement for a while, but did not recall if they notified the provider about Patient #1 not having a bowel movement.

4. During an interview on 2/9/22 at 10:00 AM, ARNP E revealed they expected the nursing staff to inform them about the patient assessments. ARNP E relies on the nursing staff to document the patient's bowel movements, so ARNP E can determine the appropriate treatment for a patient. ARNP E did not remember the nursing staff notifying ARNP E that Patient #1 had not had a bowel movement for potentially over 10 days.

5. During an interview on 2/8/22 at 4:40 PM, the Director of Nursing acknowledged that the nursing staff failed to document when Patient #1 last had a bowel movement and failed to notify a provider when Patient #1 went more than 2 days without having a bowel movement.