Long-Term Care Survey Alert

A common condition can be a clue to an impending medical catastrophe.

Case in point: Fecal impaction may present as overflow diarrhea, cautioned Malcolm Fraser, MD, CMD, in a presentation at the March 2009 American Association of Nurse Assessment Coordinators meeting in Kansas City, Mo. He recounted a lawsuit involving a resident who developed diarrhea on the Friday before a long holiday weekend. The covering doctor on day one ordered medication to treat the diarrhea, as did different covering physicians on days two and three. On day four, the resident died as the result of a fecal impaction.

Smart strategy: Whenever Fraser orders routine meds to treat diarrhea, he asks the nursing staff to measure the patient's abdominal circumference at the umbilicus daily until the diarrhea resolves. If the diameter increases by more than an inch, that could be a sign of fecal impaction, which requires a further diagnostic work-up to detect, such as a KUB (abdominal x-ray), he noted.