HospitalInspections.org
Bringing transparency to federal inspections
NEW YORK-PRESBYTERIAN HOSPITAL
THERAPEUTIC DIETS
Tag No.: A0629
Based on medical record review, document review and staff interview, in 1 of 3 medical records reviewed, the hospital failed to provide adequate calories, and protein to meet the needs of patients with pressure injury (Patient # 1).
This failure may have placed the patient at increased risk for nutritional deficits
Findings include:
Review of facility policy titled "Nutrition Standards of Care: Pressure Injury," last revised 5/2017 revealed a "Pressure Injury Nutrition Care Grid" with nutrition recommendation for calorie, protein, fluid needs for each stage of pressure injury. For example, patients with "Unstageable Pressure Injury/Deep Tissue Injury" should receive 30-40 calorie/kilogram.
Review of medical record for Patient #1 identified: A 64-year-old patient with recurrent grand mal seizures. Initial Nutrition Assessment by the Clinical Dietitian on 1/13/19 noted the patient was intubated and was currently NPO (nothing by mouth). The patient had an unstageable (when a wound cannot be staged because the depth is unknown) pressure injury to sacrococcygeal (Area pertaining to the sacrum and the tail bone) that measured 11 centimeter (cm) x 11 cm
The Estimated Nutrition Needs of the patient are: 2176 calories (20-22 cal/kg.), 130-173 gm Protein (1.5-2 gm/kg) and 1ml fluid/kg.
Based on the document titled "Pressure Injury Nutrition Care Grid," the patient's nutritional needs were not met from 1/13/19 to 3/13/19.
On 1/17/19, nutrition reassessment noted the patient had been NPO for 2.5 days, Enteral nutrition (EN) feeding started on 1/14/19. EN feeding provided the patient an average of 1830 calories which met 84% of the estimated calorie needs and 97 % of the estimated protein needs.
On 1/30/19, nutrition reassessment shows that the patient received 1684 calories and 108 gm of protein.
On 2/19/19, nutrition reassessment revealed the patient received an average of 1269 calories and 91 gm of protein.
Similar findings regarding the lack of provision of adequate nutrition were noted in the nutrition reassessments conducted by the dietician on 1/23, 2/5, 2/12, 2/26, 3/6 and 3/13/19.
On 5/9/19 at approximately 2:00 PM, during interview with Staff N, Administrative Director of Nutrition, staff acknowledged findings.