HospitalInspections.org

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Based on record review, observation, interview, and policy review the facility failed to 1) ensure the nutritional needs of 1 inpatient (#1) out of 2 inpatients and 3 discharged patients (#'s 21; 22; and 23) out of 21 discharged patients reviewed met with the therapeutic diet requirements established for nutritional problems ; 2) Failed to ensure the dietary process for obtaining food products for therapeutic diets was followed; and 3) Failed to ensure kitchen staffs were adequately trained to ensure therapeutic diet menus were followed. These failed practices placed inpatient (#1) and discharged patients (#'s 21; 22; and 23) at risk of not maintaining acceptable parameters of nutritional status. Findings:

Clinical Record Review

During a review of Patient #1's clinical record on 8/17/15 revealed the patient had been admitted to the hospital's swing bed status on 7/6/15. The Patient's diagnoses included high blood pressure, edema, and shortness of breath. The Patient's nursing assessment and vital sign review revealed the Patient had problems with edema, and unstable blood pressure ranging from 170-200's systolic and 70-90's diastolic. Review of a physician order, dated 8/3/15, revealed an order for the patient to have a renal diet. Further review revealed the dietary department had started providing the renal diet as of 8/3/15.

Review of the menus from 8/3/15 - 8/17/15 revealed Patient #1 had consistently received frozen entrees for lunch and dinner meals.

Review of the menus provided to inpatients at the facility between 7/1/15 - 8/17/15 revealed there were 12 patients for whom therapeutic diets had been ordered. Out of the 12 inpatients 2 (#'s 1 and 21) were on a renal diet and 2 (#'s 22 and 23) were on low sodium diets.

Observations

During a walk-through of the hospital's kitchen on 8/17/15 from 3:15 - 3:30 pm revealed 4 kinds of Lean Cuisine frozen entrees located in the kitchen's freezer. Review of the nutritional values of each one-serving frozen entree revealed the meals had between 550-680 mg of sodium.


Interviews

During an interview on 8/17/15 from 4:00-4:10 pm Staff #1 disclosed the patients who were on therapeutic diets and those who were on regular diets were all offered the same lunch and dinner choices. These choices were frozen entrees (usually Lean Cuisine). When asked if these meal choices would meet the requirements for a patient who was on a therapeutic diet like a renal or low sodium diet Staff #1 said he/she did not know and he/she had always worried about giving the frozen meals to patients who had food restrictions because he/she knew the frozen meals had a lot of sodium in them. Staff #1 said there were some other types of foods that could be provided, but usually patients were given a choice of the frozen entrees. The Surveyor asked if the dietary staff had ever been provided training on how and what to prepare for the patients meals who were on therapeutic or regular diets. Staff #1 said no, that he/she had not had any training in the kitchen other than to read the different instructions located on the walls or by word of mouth from other people working in the kitchen.

During an interview on 8/18/15 at 8:50 - 9:00 am Staff #2 disclosed that when he/she prepared lunch and dinner meals for patients in the hospital he/she used the frozen meals most frequently. He/she said that prior to the meal-times he/she would take inventory of what was in the kitchen to cook and tell them what frozen meals were available and allow patients to pick from them. The Surveyor asked if there was a menu that staff followed and Staff #2 said at one-time there was a menu that was followed, but for a few months the food on the menu had not match what was available to serve so the menu was no longer used. When the Surveyor asked if he/ she had been informed whether the frozen meals were appropriate for those patients on therapeutic diets like low sodium or a renal diet? Staff #2 said he/she did not know and worried about them not being appropriate. The Surveyor asked if Staff #2 had ever been trained in how to process; prepare; and cook food and Staff #2 said prior to coming to the hospital he/she worked at the local long-term care and felt he/she understood how to prepare food. Staff #2 said he/she had not been specifically trained about food prep at the hospital. The Surveyor asked who provided the frozen meals for the hospital kitchen and Staff #2 said (name omitted) the Dietary Supervisor stocked the hospital kitchen with food. Staff #2 said that sometimes the frozen meals would come from the long-term care's kitchen but also staff would go and pick up frozen meals from the local supermarket when they ran out of the more popular varieties.

During an interview on 8/18/15 at 9 am with the Dietary Supervisor and the Hospital Dietician, the Hospital Dietician disclosed the frozen entrees used as meals for hospital patients met the dietary needs of those patients on therapeutic diets. The Dietician said that he/she had researched and provided the hospital staff with a listing of what name brands of frozen meals that was to be used for those patients on restricted diets. The dietician brought a printed form of the name brands and types of frozen meals to be used. The listing of foods also had the nutritious values contained in each meal. The sodium levels referenced on the list were between 150-440 mg. When the surveyor explained that all of the meals in the hospital's freezer contained 1-3 times more sodium the Dietician was surprised. The Dietician was unaware the hospital staff were buying meals at the local supermarket. When the Surveyor asked if he/she ever checked up on the staffs understanding of the established menus or if he/she had ever done in-services for the hospital staff and their understanding of what therapeutic diets were, the dietician said he/she had provided printout outs of therapeutic diets and what foods were to be chosen or limited from the major food groups. Further stating that no structured in-service training had been provided for staff.

The Surveyor asked if Lean Cuisine meals containing between 550-780 mg of sodium met the requirements of a therapeutic renal or low sodium diet and the Dietician confirmed they did not.

Review of the facility 's policy "Facility Nutrition Program", last date reviewed 12/2014, revealed "Ensure that Elders are served the correct prescribed diet..." and the Dietitian/Dietary manager 2. Oversee activities and functions of staff handing food as well as food storage & preparation, sanitation issues, and menu planning/preparation."

Review of the facility's policy "Menus" last date reviewed 12/2014, revealed "...menus shall (c) be followed."

Review on 8/19/15 of Staff #'s 1 & 2 training records revealed no training related to food preparation, therapeutic diets, or kitchen cleaning specific to the hospital kitchen.

A renal diet controls the amount of protein and phosphorus in your diet. You may also have to limit calcium, sodium, and potassium. A renal diet can help decrease the amount of waste made by your body, which can help kidneys work better.

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