Sandstone Health Care: 6-Day Constipation Crisis - MN
The resident, identified as R3 in inspection records, told inspectors on April 6 that she thought she was "backed up" and hadn't had a bowel movement since the previous Monday. Her electronic medical records showed no evidence that staff had conducted bowel assessments or contacted her healthcare provider about the ongoing constipation.
According to the facility's standing orders, staff should begin interventions on day two without a bowel movement, starting with prunes, prune juice or other dietary measures. By day three, they should administer milk of magnesia or lactulose. Day four calls for bisacodyl suppository followed by a tap water enema if needed.
The records showed spotty adherence to these protocols. Staff documented giving the resident prunes, prune juice or other dietary interventions only once on April 1. On April 5, after she had gone without a bowel movement for multiple days, they administered milk of magnesia once. By April 6, day five of the constipation episode, orders called for using medications and dietary interventions "every day and evening shift" until results were achieved.
The resident finally had a bowel movement on April 7, according to documentation.
During interviews, staff revealed confusion about their responsibilities and protocols. Nursing assistant NA-B, who was caring for R3 on April 8, confirmed she would be responsible for documenting the resident's bowel movements but seemed unclear about the broader assessment requirements.
Licensed practical nurse LPN-C explained that staff would ask residents each shift whether they had bowel movements, then document the responses. She said only nurses could see how many days had passed since a resident's last bowel movement.
Assistant director of nursing RN-C described the overnight nurse as responsible for running bowel reports and entering orders for the day shift. She said their protocol started on day two without a bowel movement, and "if a resident had gone five or six days without then she believed you would do the enema, but added the residents had the right to refuse as well."
RN-C acknowledged that nurses "are pretty good about updating the doctor if they are having constipation issues" but admitted she hadn't performed assessments as part of the protocol. Looking at R3's case specifically, she noted the provider was never notified and said she would have expected prescription medications to be used.
The assistant director also acknowledged the serious health risks involved. "There was always the risk of impaction or obstruction, leading to perforation or infection," RN-C told inspectors.
Director of nursing stated her expectation was clear: "If staff were using the bowel protocol, and things weren't working they should be reaching out to the provider to update them to see if they need further intervention and would expect them to do an assessment as they were going on without effectiveness."
The facility's standing orders specify precise dosages for interventions. Milk of magnesia should be given at 30 milliliters orally as needed daily, with a warning not to administer to residents with end-stage renal disease or dialysis. Lactulose should be given at 30 milliliters by mouth daily as needed. Bisacodyl suppository calls for 10 milligrams rectally daily as needed, followed by 500 milliliters of tap water enema if necessary.
Inspectors requested the facility's formal policy regarding bowel management procedures but never received it.
The violation affected few residents and resulted in minimal harm, according to the inspection report. However, the case highlighted systemic failures in following established protocols and communicating with healthcare providers about residents' medical needs.
R3 was noted as someone who typically refused some medications and took herself to the bathroom independently, factors that may have complicated her care but didn't excuse the lack of proper assessment and provider notification when her condition persisted for nearly a week.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Sandstone Health Care Center from 2026-04-08 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
SANDSTONE HEALTH CARE CENTER in SANDSTONE, MN was cited for violations during a health inspection on April 8, 2026.
By day three, they should administer milk of magnesia or lactulose.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.