There has been a great deal of talk as of late regarding a fleets and their dangerousness in older patients and palliative care patients.
I just read on my company email an educational blurb regarding this. So a fleets is not the first line of thought for constipation in a chronically/terminally/geriatric patient due to the effect on electrolytes and kidneys. It also went on to talk about fleets being put in the pharmacy, and not out on the floor (as some facilities, you have them in the supply room).
I would call your malpractice insurance
, speak to a union rep if you are a union facility, and going forward, suggest that you look into getting a bowel protocol and standing orders for your palliative care patients. This would be something that your DON can bring to the medical staff and pharmacy.
No matter what an MD says at any time, I would always be on top of getting an order for anything. If nothing else, I would also question why it took 6 DAYS for someone to realize the mirilax was not working, and there was no BM. This is a process error and doesn't bode well for patient care.