12/11/2025

Survey Tip of the Week: Bowel Management

Deficiencies related to bowel programs often stem from inconsistent implementation, gaps in reassessment, or failure to anticipate predictable side effects, especially with opioid use. Under §483.25 Quality of Care, residents have the right to receive treatment and services to maintain or improve normal bowel function. Surveyors will expect facilities to demonstrate that bowel management programs are based on comprehensive assessments, are consistently implemented as written, and are reviewed and revised when the resident’s condition, medications, or responses change. This includes ensuring that interventions such as increased fiber, adequate fluids, bowel medications, toileting schedules, and hygiene assistance are delivered reliably and documented appropriately.

Two examples from Appendix PP illustrate how seemingly small inconsistencies can result in deficiencies:

• Missed Bowel Regimen with Opioids: A hospice resident on a pain management program using opioids experienced avoidable discomfort because the facility did not consistently implement the bowel management plan outlined in the coordinated care plan. Even episodic minimal discomfort due to predictable opioid-related constipation can rise to Level 2 severity when interventions are not followed as planned.
• Inconsistent Fiber/Hygiene Support for Fecal Incontinence: Another resident, alert and aware of her care needs, reported intermittent fecal incontinence and relied on a bowel program involving extra fiber and increased liquids. Changes in dietary service led to missed fiber supplements, and inconsistent staff assistance with hygiene caused the resident to stop attending activities she enjoyed. Surveyors cited the facility for failing to provide appropriate treatment and services—evidence of the significant impact on the resident’s dignity, social engagement, and psychosocial well-being.

Surveyors will also interview residents and staff to determine whether bowel management practices are understood and consistently implemented. They may review bowel records, MARs, care plans, and monitoring documentation to confirm that ordered interventions are followed and that reassessments occur when constipation persists or worsens. If concerns arise, surveyors will evaluate whether the facility’s policies, procedures, and staff training clearly outline expectations for bowel programs, monitoring, and timely response to changes in condition.