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Based on interview, record review and a review of facility documentation, the facility failed to ensure that nutritional needs as understood through the interpretation of calorie counts were in accordance with orders for calorie counts being fulfilled for the practitioner's responsible for the care of patients for 1 of 10 sampled patients (#1).

Findings:

A review of the medical record of patient #1 was performed. The patient was triaged in the Emergency Room (ER) at 6:54 PM on 7/16/14. A nurse's note of 7/16/14 indicated that the patient was transported to the floor at 9:40 PM.

Physician orders of 7/26/14 at 3:43 PM read, "Calorie count times 2 days." This order would be in force through 7/28/14. A nurse's note of 7/28/14 at 9 AM read, "On calorie count." Regarding the preceding two day order for a calorie count, there was no evidence in the medical record that this was performed.

A Case Management note of 7/28/14 at 3:50 PM read, "Reviewed with ... CN (charge nurse) this morning who informed that ... MD (medical doctor) wants calorie count for 24 hrs before determination for peg tube." Physician orders of 7/28/14 at 4:53 PM read, "Continue calorie count for another 24 hours." A physician note of 7/28/14 at 5:09 PM read, "Spoke with (patient's spouse)....over the phone and explained patient's medical status.... explained that patient is on a calorie count as requested by gastroenterology."

A gastrointestinal physician note of 7/30/14 at 10:25 PM read, "Plan: ... Continue calorie count." An "Adult Nutrition Re-Assessment" of 7/30/14 at 12:55 PM read, "Calorie count underway... GI (Gastro Intestinal) recommends calorie count and soft meals. No C/S (consult) received for calorie count. RN and charge nurse indicated informal calorie count done on the floor for 24 hrs...." As with the prior orders of 7/26/14 for a calorie count, there was no evidence in the record that the 7/28/14 renewal of calorie count orders was followed.

A review of facility policy "Calorie Count" read, "To provide a calorie count for patients when ordered by a Physician....The Dietician will be notified via the Meditech system of a physician ordered calorie count.... At the completion of the calorie count, the Dietician evaluates that patient's intake, documents the results in the patient 's electronic medical record and makes nutritional recommendations." This policy was not followed with respect to the orders.

During an interview of the Direct of Quality on 8/07/14 at 1:10 PM, she confirmed that the orders for calorie counts and the above mentioned policy were not followed.