HospitalInspections.org

Based on interview, document review, and policy review the hospital failed to ensure menus meet the daily nutrition needs of patients in accordance with recognized dietary practices. This deficient practice has the potential to affect all patients and lead to inadequate intake of nutrients, harm, or other adverse outcomes.

Findings Include:

Review of the hospital's document titled, "Job Title: Dietary Services, Director," undated, showed "Duties and responsibilities . . . responsible for the management, and direction of dietary services throughout the facility; ensures food and dietetic services are carried out daily; . . . ensures compliance with dietary policy and procedures . . . supervision of the menu planning function."

Review of the hospital's policy titled, "Daily Therapeutic Diet Manual for Clinical Nutrition Management," last reviewed February 2020, showed "The general healthful diet is composed of foods low in fat, cholesterol, and sodium and high in fiber. This diet emphasizes protein sources other than red meat and includes low-fat or fat-free dairy products, whole grains, and at least five servings per day of fresh fruits and vegetables."

Review of the hospital's document titled, "Regular Diet Menu (low fat)," undated, showed that patients have the option to choose a "Full Meals" option or could choose from a list of a variety of items. The full meal option did not include any fresh fruit or vegetables. Fruit options included unsweetened applesauce, raisin bran cereal, yogurt, or factory sealed fruit cups. Vegetable options included the vegetables in frozen meals or tomato soup. The menu does not allow room for fresh vegetables or fruit to be added by the patient if it is desired. The menu does not prompt patients or person assisting patient with ordering to choose a variety of foods to cover all food groups.

Review of the hospital's document titled, "2,000 Calorie Diet Menu," undated showed "Full Meals" options did not include any fresh fruit or vegetables. If a patient did not want a meal option, they can "Mix and match choices total no greater than (6) carbs." The options are broken into Protein options, carbohydrate options, soups in a cup, and other options. The menu does not encourage a well-rounded meal from each food group to ensure adequate nutrition. The mix and match options does not include fresh fruit and vegetable choices. Macaroni and cheese in a cup did not include a carb count. The menu does not allow room for fresh vegetables or fruit to be added by the patient if it is desired.

Review of the hospital's document titled, "1,800 Calorie Diet Menu," undated, showed "Full Meals" options did not include any fresh fruit or vegetables. The mix and match choices "total no greater than (5) carbs," broken down into protein options, carbohydrate options, soups in a cup, and other options. The menu does not encourage a well-rounded meal from each food group to ensure adequate nutrition. Macaroni and cheese in a cup did not include a carb count. The menu does not allow room for fresh vegetables or fruit to be added by the patient if it is desired.

Review of the hospital's document titled "1,500 Calorie Diet Menu," undated, showed an option to choose a frozen meal or an option to mix and match with no greater than (4) carb options. The mix and match options are broken down into protein options, carbohydrate options, soups in a cup, and other options. The menu does not encourage a well-rounded meal from each food group to ensure adequate nutrition. Macaroni and cheese in a cup did not include a carb count. The menu does not allow room for fresh vegetables or fruit to be added by the patient if it is desired.

Review of the hospital's document titled, "Full Liquid Diet," does not include options for fruit or vegetable juices or a complete nutritional drink option.

During an interview on 09/23/21 at 10:55 AM, Staff D, Nurse Manager, stated that menus are available for patients to order meals while in the facility. If a patient does not like the options that are available, they may order from a popular delivery service (an online food delivery service from restaurants). Staff D stated that the nurses do not place the order for the patients but do try to guide them on food choices that would be acceptable for the patient's diet. The staff does not log the food choices. Only a percentage of the amount of food is written on the input/output monitoring sheet in the chart. Staff does not record amount of carbohydrates, protein, or calories to ensure the patient is receiving the appropriate diet, and nutrients required per national guidelines. Staff D stated that she has not read the Nutritional Care Manuel, or the Therapeutic Diet Manuel, but is aware of how to access it. She stated she spends about five to seven hours a week on her position as Interim Dietary Services Director. She further stated that her training for the position was completed by Staff B, Chief Medical Officer (CMO) on 04/22/21.