Aperion of Wilmington resident suffers ruptured colon due to fecal impaction

Описание: IDPH issued to Aperion Care of Wilmington after a resident there suffered a fecal impaction, which resulted in a rupture of his colon, requiring removal of his colon and placement of an ileostomy.
My name is Barry Doyle. I'm a lawyer in Skokie practicing nursing home abuse and neglect work throughout the State of Illinois. I'm also the author of Built to Fail, a free report available for download from my website, which spells out how the nursing home business model inevitably results in unnecessary injuries and deaths for nursing home residents.
The resident who was involved in this incident suffered from mental illness and was on psychotropic medications. Psychotropic medications increase the risk that the people receiving them will experience constipation. When a nursing home resident is on psychotropic medications, one of the standard measures that is put into place in a nursing home setting is to develop a care plan to address the risk of constipation. Typically, that care plan will include monitoring the resident for signs and symptoms of constipation, as well as tracking their bowel movements.
Prolonged periods of constipation creates an increased risk that the resident will experience fecal impaction. When there is fecal impaction, there are hard balls of feces that form in the digestive tract, which are simply difficult to impossible for muscular movement to push through down to the end of the digestive tract. This can create abdominal pain and other digestive issues, and taken to the extreme it can cause perforation of structures within the digestive tract.
When there is perforation or rupture of the digestive tract, the contents of the digestive tract spill out to the abdominal cavity. This causes an infectious process known as peritonitis, and that's a very painful condition and which is very difficult to resolve. It often requires a prolonged course of IV antibiotics and multiple surgical procedures, frequently with removal of some structures within the digestive tract, often a section of intestine or the colon.
In this particular case, the resident was discovered on the day that he was taken to the hospital to be in bed bleeding from the rectum. The staff saw that there was blood within the toilet, and the resident was brought to the hospital. The resident underwent a CT scan of the abdomen, which showed that there was free air within the abdominal cavity. This is a sign that there is an actual rupture of structures within the digestive tract. The resident was brought to surgery where it was discovered that there was a complete rupture of the colon, that there was digestive contents throughout the abdomen, and that there was extensive evidence of infection throughout the abdominal cavity. Furthermore, they found that there were several large balls of feces in the digestive tract. There was also evidence that there was some necrosis of the colon. All of this is an indication that this was a condition which had been present for several days. Ultimately, this resident had multiple surgeries done. He had to have his colon removed, and then had to have an ileostomy.
When IDPH went to the nursing home to investigate this particular incident, they questioned the staff about the tracking of bowel movements in the resident's chart. It became evident from the questioning that was placed by the Department of Public Health to the staff there that there was no good tracking of this resident's bowel movement habits. The staff was unable to explain the various things that were recorded in the chart. So the ultimate conclusion of this was that the resident's bowel movements weren't being tracked in any kind of meaningful way. As a result, he experienced constipation over a prolonged period of time.
We know this given the findings during surgery with the complete rupture of the colon, the necrosis of the colon, and the multiple large fecal balls that were discovered during the surgery. So this is a condition which ultimately should have been very preventable. If this resident was experiencing constipation, there are a number of steps that could be taken to help the resident go to the bathroom and resolve this fairly simply. It can be a matter of giving laxatives, or stool softeners, or any number of other relatively mild medications that would have helped the resident go to the bathroom, and this really catastrophic outcome would have been very easily avoided.
However, for the staff to do this the basic task of tracking the resident's bowel movements had to be followed, and obviously it wasn't being done in this particular incident, with really lifelong catastrophic outcomes for this particular resident.
I hope you found this interesting. If you have any questions regarding this or any other nursing home abuse and neglect issue, please feel free to reach out to us. Our number is (312) 263-1080, or we can be reached on the internet at wwwaccidentlawillinois.com. Thanks for watching.