IDPH has cited and fined Aperion Care Wilmington nursing home after a resident there developed fecal impaction which led to a ruptured colon which required multiple surgeries.
The resident at issue suffered from mental illness and was receiving several psychotropic medications. One of the risks associated with the use of these kinds of medications is that the resident will suffer from constipation. When a resident is receiving psychotropic medications, one of the steps typically included in the resident care plan is to monitor the resident for signs and symptoms of constipation as well as tracking their bowel movements.
Prolonged periods of constipation increases the risk that the resident will experience fecal impaction. When someone suffers from fecal impaction, there a hard balls of feces in their digest tract which are hard to push through to the end of the digestive tract. The presence of a fecal impaction can cause abdominal pain and other digestive issues, and in advanced cases can cause perforation of the structures of the digestive tract.
Perforation or rupture of structures in the digestive tract results in the contents of the digestive tract leaking out into the abdominal cavity. The causes a type of infection known as peritonitis. Peritonitis is very painful and can be a life-threatening condition. It is also a very difficult condition to treat and often requires a prolonged course of IV antibiotics and may require multiple surgeries to remove portions of the digestive tract.
The resident was discovered in bed with blood coming from his rectum the day that he was taken to the hospital. Additional blood was found in the toilet. At the hospital, the resident underwent a CT scan which showed the presence of free air in the abdominal cavity. This is a sign of rupture of one of the structures in the digestive tract.
The resident was brought to surgery where it was discovered that the resident’s colon had ruptured, that there were digestive contents throughout the abdominal cavity, and that there was extensive evidence of infection throughout. Several large balls of feces were found within the digestive tract. There was also evidence of necrosis (tissue death) of the colon. All of this indicated that this was a condition which was present for several days.
Ultimately, the resident underwent several surgeries, including removal of his colon and placement of an ileostomy, which is similar to a colostomy except that it removes waste matter from the end of the small intestine rather than the colon. Besides being an issue of dignity, this has significant negative impacts on the nutrition of the resident.
When IDPH went to investigate this incident, they questioned the staff about the tracking of the resident’s bowel movements in the chart. The answers made it apparent to the surveyor that there was no meaningful tracking of the resident’s bowel movements. As a result this led to the resident suffering prolonged periods of constipation.
Had the resident’s bowel movements truly been tracked in a regular, systematic way, the resident’s constipation could have been addressed in a number of fairly simple ways, ranging from diet changes, use of a laxative or stool softener, or digital removal. This was not done, leading to a catastrophic outcome for this resident.
Additionally, the resident was suffering from necrosis of the colon and from a significant infection at the time he was brought to the hospital and this had likely been present for a long time before this. This is a strong indicator that the staff was not monitoring the condition of the resident and did not notify the resident’s physician of changes in the resident’s condition.
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