Long-Term Care Survey Alert

Published on Fri Sep 15, 2006 PDF

Simple prevention can protect your residents and survey record.


Physicians who use opioids to treat serious pain can get an A in effective pain management. But they will earn their facilities an F tag if they fail to head off one of the notorious side effects of such medications.

The clinical reality: Opioids are known for causing constipation, which can lead to fecal impaction, a sentinel event in the survey world. And fecal impaction can "lead to serious problems, including urinary retention and delirium," says Karl Steinberg, MD, CMD, an associate director of a nursing facility in Oceanside, CA. In fact, he knows of a patient who developed a perforated colon due to a fecal impaction.

That's why "clinicians usually order a mild laxative for a patient when he begins an opioid medication," says Carla Saxton McSpadden, RPh, CGP, with the American Society of Consultant Pharmacists. The patient should "receive the laxative on a routine basis and not just PRN," she adds. "Some patients will require more than one medication to prevent constipation -- for example, Senokot (Senna) or Miralax (polyethylene glycol) and then a PRN."

Real-world tip: As a strategy to prevent constipation, Windsor Place makes sure residents receiving opioid medications receive adequate fluids. In fact, the nursing staff puts the residents on intake and output to monitor their fluid status, according to Barbara Golden, director of nursing for the facility in Daingerfield, TX. They also offer the residents fruit and fruit juices, which staff deliver on a "good humor cart." The selection includes grapes, plums and prune juices. "We also offer them plum juice, which acts as a laxative but is less harsh," says Golden.