LAUREL, MS - A Mississippi nursing home failed to properly monitor a resident's bowel movements and implement appropriate interventions, resulting in the resident's hospitalization for severe fecal impaction, according to a federal inspection report.

Failure to Monitor Critical Health Functions
Federal inspectors at Laurelwood Community Living Center found that staff failed to follow established care protocols for monitoring bowel movements, despite having clear policies in place. The facility's own care management policy required ongoing assessments and care plan revisions as residents' conditions changed, but documentation revealed significant gaps in monitoring and intervention.
The inspection focused on Resident #25, a cognitively intact woman who had been admitted to the facility in March 2022 with a documented history of constipation. Her care plan specifically identified her as being at risk for constipation due to multiple medications, with goals stating she should have a normal bowel movement at least every three days.
Documentation review revealed alarming patterns of missing bowel movement records. In January 2025, there were no documented bowel movements for multiple consecutive periods, including January 1-3, 5, and a concerning six-day stretch from January 14-19. Additional gaps occurred on January 23, 24, and 28.
Medication Management Failures
The facility's medication administration records revealed a critical oversight in pharmaceutical management. Despite the documented absence of bowel movements, Resident #25 continued to receive Lomotil, an anti-diarrheal medication, three times daily. This medication works by slowing intestinal motility, which can worsen constipation when administered inappropriately.
Simultaneously, MiraLAX, a laxative that had been ordered on an as-needed basis specifically for constipation management, was not administered during the periods when the resident had no documented bowel movements. This represents a fundamental failure in medication management protocols.
Medical literature establishes that prolonged use of anti-diarrheal medications like Lomotil in patients with existing constipation can lead to severe complications. The medication reduces intestinal contractions, which normally help move waste through the digestive system. When combined with existing constipation risk factors, this can create a dangerous cycle leading to fecal impaction.
Severe Medical Consequences
The failure to properly monitor and intervene resulted in the resident's hospitalization from January 30 through February 4, 2025, with a primary diagnosis of fecal impaction. This condition occurs when stool becomes so hardened and compacted in the intestines that normal bowel movements cannot occur naturally.
Fecal impaction represents a serious medical emergency that can lead to multiple complications. The condition can cause severe abdominal pain, nausea, and vomiting. More seriously, it can lead to intestinal obstruction, perforation, or rectal bleeding. In this case, the resident subsequently developed hemorrhage of the anus and rectum, conditions that were added to her medical record with an onset date of February 5, 2025.
The resident's daughter confirmed the severity of the situation in a phone interview, explaining that her mother "did not have a bowel movement for a week" and required transfer to an acute hospital in another state, where she remained for nearly a week due to the severity of her bowel impaction.
Communication Breakdown Between Staff and Providers
Interviews with facility staff revealed significant communication failures that contributed to the incident. The facility's physician confirmed he was not informed about the consecutive days without bowel movements prior to the hospitalization. He stated that had he been notified of the six consecutive days without documented bowel movements, he would have implemented appropriate orders for constipation management.
The Director of Nursing acknowledged in a follow-up interview that there was "no documentation of nursing interventions, constipation medications administered, or provider notification regarding the gaps in bowel movements prior to the hospitalization." She also admitted to being unaware that the resident was not having bowel movements, despite facility protocols requiring notification after three consecutive days without documented bowel movements.
Industry Standards and Protocol Requirements
Standard nursing home protocols require systematic monitoring of residents' elimination patterns, particularly for those with documented constipation risks. When a resident has not had a bowel movement for three consecutive days, nursing staff should implement interventions such as administering prescribed laxatives, increasing fluid intake, encouraging mobility when possible, and notifying the attending physician.
The facility had appropriate standing orders in place for managing constipation, and the physician confirmed these protocols existed. However, the breakdown occurred in the implementation and documentation of these standard procedures.
Proper bowel management in long-term care settings requires careful attention to medication interactions. When residents are prescribed both anti-diarrheal medications and laxatives, nursing staff must carefully assess the clinical situation before administration. Continuing anti-diarrheal medications during periods of constipation contradicts basic pharmaceutical safety principles.
Additional Issues Identified
The inspection revealed broader systemic issues with care plan implementation and documentation. Despite having comprehensive, person-centered care plans that included measurable objectives and intervention strategies, the facility failed to follow its own established protocols.
Staff interviews indicated that while policies existed requiring notification of physicians when residents experienced prolonged periods without bowel movements, these communication protocols were not consistently followed. The facility's care plan nurse confirmed that care plans should provide guidelines for individualized resident care, but acknowledged gaps in implementation.
The incident highlights the critical importance of systematic documentation and monitoring in long-term care settings. Regular assessment of basic bodily functions like elimination patterns serves as an early warning system for potentially serious medical complications.
Fecal impaction, while preventable with proper monitoring and intervention, can rapidly progress to life-threatening complications when left unaddressed. The condition is particularly concerning in elderly residents who may have multiple contributing factors such as decreased mobility, medication side effects, and underlying medical conditions.
The inspection findings demonstrate how communication failures between nursing staff and physicians can have serious consequences for resident health outcomes. When established protocols exist but are not consistently implemented, residents face unnecessary risks for preventable complications.
This case underscores the fundamental importance of consistent documentation, appropriate medication management, and timely communication with healthcare providers in maintaining resident safety and health in long-term care facilities.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Laurelwood Comm Living Center from 2025-04-10 including all violations, facility responses, and corrective action plans.
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