HospitalInspections.org

Based on review of facility documents, medical record review (MR) and interview of staff (EMP), it was determined that the facility failed to adequately address the nutritional status throughout admission for one of one medical records reviewed (MR1).

Findings include:

Review on August 31, 2011, of the facility policy "Nutrition Care Process Policy," last reviewed October 2009, revealed "Nutrition Screening and Assessment ... Procedure: ... All swing admissions present during the consultant RD (registered dietician) visits will be assessed and monitored via the nutrition care process. All swing bed admissions will be followed by the consultant RD monthly, and as needed. ..."

Review on August 30, 2011, of the facility policy "Pressure Ulcer Prevention," last revised October 2005, revealed "... Procedure: ... 3. Preventative measures include: ... Seek a dietary consult when inadequate dietary intake is suspected. ..."

Review on August 30, 2011, of a document provided by the facility revealed laboratory work completed at another facility on May 29, 2011. The laboratory results revealed a low albumin level of 1.9.

Review on August 30, 2011, of MR1 revealed the patient was admitted to the facility on June 1, 2011, with the diagnosis of Stage IV sacral decubiti (pressure ulcer), malnutrition, immobility, de-conditioning, and a midline abdominal wound. The patient was discharged on August 8, 2011.

Weights for MR1 were recorded as:
Body weight of 113 pounds on June 2, 2011.
Body weight of 107.5 pounds on June 10, 2011.
Body weight of 106.5 pounds on June 29, 2011.
Body weight of 98.6 pounds on July 6, 2011.
Body weight of 100.5 pounds on July 14, 2011.
Body weight of 104.8 pounds on July 27, 2011.

Review of tube feeding orders in MR1 revealed the following:
June 1, 2011, Pronits [sic] 70 cc (cubic centimeters) per hour was ordered.
June 6, 2011, Jevity 30 cc per hour continuously was ordered.
June 7, 2011, Jevity 50 cc per hour at night and 40 cc per hour during the day was ordered.
July 1, 2011, Jevity 60 cc at night and 40 cc during the day was ordered.
July 20, 2011, Jevity 60 cc per hour continuously was ordered.

Further review of MR1, revealed no protein or albumin laboratory levels were obtained during MR1's admission to Troy Community Hospital.

A nutrition assessment in MR1, dated June 6, 2011, revealed the following below normal laboratory values: sodium 131, chloride 97, magnesium 1.6, total protein 6.3 and albumin 1.9. The nutritional recommendation was to continue the tube feedings, encourage oral intake, and give a multivitamin daily. There were no further nutritional assessments completed on MR1.

MR1's discharge summary of August 8, 2011, revealed discharge diagnoses of severe malnutrition and deconditioning in the setting of multiple underlying pathologies, coincidental stage IV sacral decubitus with osteomyelitis and open abdominal wounds, status post colectomy with construction of an ileostomy (artificial opening through the abdominal wall into the bowel), and left hip replacement following a hip fracture.

Interview with EMP1 at approximately 12:00 PM on August 31, 2011, confirmed the above listed body weights, the absence of protein and albumin laboratory testing for MR1 after admission to Troy Community Hospital, and that one nutritional assessment was completed for MR1 at Troy Community Hospital during the patient's admission June 1, 2011 to August 8, 2011.

Review on August 30, 2011, of a document provided by the facility revealed a consult performed at another hospital dated August 8, 2011, "Physician Progress Note ... Plan: Admit to inpatient status. 1. Failure to thrive: Regular diet with GJ (gastrojejunostomy) tube (tube into the stomach) feed at Goal. Will check CMP (comprehensive metabolic panel), pre albumin, magnesium and phosphorus levels. ..."

Review on August 30, 2011, of a document provided by the facility revealed a consult performed at another hospital dated August 8, 2011, "Physician Progress Note ... Severe protein calorie malnutrition - reported 14 pound weight loss since entering rehab (likely fluid weight?). Will assess nutritional parameters and reestablish enteral tube feeding at goal requirement rate. Her daughter reports they have been reducing her tube feeding in an attempt to increase her PO (oral) intake. I disagree with this approach. She is severely malnourished, with a poorly healing surgical wound and a stage 4 sacral decubitus ulcer, and has a gastric tube. In my opinion, PO intake should be for comfort only and all nutritional needs should be met via the G-tube (stomach tube) until she has recovered. ..."