Get Moving on Constipation

Dear Dr. Jeff: Recently our facility had a patient who complained of abdominal pain and vomiting. She was sent to the emergency department where she received a Fleet enema and was returned with a diagnosis of “fecal impaction.” The family complained to surveyors who cited us for a Level G deficiency and imposed a $5,000 fine. The facility leadership has focused on the decision to transfer the resident to the hospital as the problem, but it seems to me that more needs to be fixed. Any suggestions?