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Based on record review and interview, the facility failed to ensure the nursing staff supervise and evaluate the nutritional needs of the patient on an ongoing basis, and follow the physician's orders for 1 (one) out of 14 sampled patients (SP#6).

The Findings:
Sampled patient #6 was admitted with cystic fibrosis exacerbation. Record review of sample patient (SP) #6 Nutrition Support Assessment dated 07/24/15 show the Pt. (patient) is at nutritional risk for greatly increased nutritional needs related to the pt's severely underweight status and hyper-metabolic condition as evidenced by the BMI (basal metabolic index- 14.4) and cystic fibrosis. The assessment also showed that the pt's IDW (ideal body weight) is 100 lbs. (pounds) and the pt. current weight is 74 lbs.

The physician orders dated 07/23/15 at 6:50 PM show physician orders which include a 1800 calorie diet, Nutren 1 can via PEG (gastric tube) TID (3 times a day) and daily weights. Further review of the physician orders dated 7/25/15 at 10:30 AM then showed an order to change to a regular die and 1 can of Ensure with each meals, 4 cans of Two-Cal for nightly tube feeds from 9 PM- 5 AM at a goal rate of 125 ml/hr.

Review of SP #6 initial nutritional consult dated 07/24/15 and the follow up nutritional consult dated 07/30/15 showed a plan/recommendations to monitor po (Per Orem) intake, TF (tube feeding) tolerance and labs.

Review of SP#6 Daily Nursing Flow Sheets showed no food intake documentation from 07/23/15 to 08/03/15. There is no tubefeeding intake documented for the in the 24 hour fluid balance 07/30/2015 to 08/02/2015. There were also no daily weights documented as ordered by the physician.

On 07/14/15 at 2:00 PM, the Clinical Practice Manager stated that the facility documents the patient's food consumption by exception; that if there's problem, they do the documentation.

Based on record review and interview, the facility failed to ensure the nursing care plan is developed with the nursing interventions to monitor the intake and daily weights in response to the identified nutritional needs of 1 (one) out of 14 sampled patients (SP#6).


The Findings:

Based on record review and interview, the facility failed to ensure the nursing staff supervise and evaluate the nutritional needs of the patient on an ongoing basis, and follow the physician's orders for 1 (one) out of 14 sampled patients (SP#6).

The Findings:
Sampled patient #6 was admitted with cystic fibrosis exacerbation. Record review of sample patient (SP) #6 Nutrition Support Assessment dated 07/24/15 show the Pt. (patient) is at nutritional risk for greatly increased nutritional needs related to the pt's severely underweight status and hyper-metabolic condition as evidenced by the BMI (basal metabolic index- 14.4) and cystic fibrosis. The assessment also showed that the pt's IDW (ideal body weight) is 100 lbs. (pounds) and the pt. current weight is 74 lbs.

The physician orders dated 07/23/15 at 6:50 PM show physician orders which include a 1800 calorie diet, Nutren 1 can via PEG (gastric tube) TID (3 times a day) and daily weights. Further review of the physician orders dated 7/25/15 at 10:30 AM then showed an order to change to a regular die and 1 can of Ensure with each meals, 4 cans of Two-Cal for nightly tube feeds from 9 PM- 5 AM at a goal rate of 125 ml/hr.

Review of SP #6 initial nutritional consult dated 07/24/15 and the follow up nutritional consult dated 07/30/15 showed a plan/recommendations to monitor po (Per Orem) intake, TF (tube feeding) tolerance and labs.

Review of SP#6 Daily Nursing Flow Sheets showed no food intake documentation from 07/23/15 to 08/03/15. There is no tubefeeding intake documented for the in the 24 hour fluid balance 07/30/2015 to 08/02/2015. There were also no daily weights documented as ordered by the physician.

On 07/14/15 at 2:00 PM, the Clinical Practice Manager stated that the facility documents the patient's food consumption by exception; that if there's problem, they do the documentation.

Based on record review and interview the facility failed to include the genitourinary and cardiology follow up referral for after discharge care for one (1) out of 10 sampled patients (SP #5).

The findings:

Sampled patient # 5 medical records showed he was admitted with hematuria and fever and was found to have a bladder stone. The patient was also with cardiomyopathy and had an echocardiogram completed that showed an EF (ejection fraction) of 25 % (55-70% Normal). Review of the physician discharge orders dated 4/16/15 at 11:06 AM showed orders which include to discharge home and to follow up with [Named] GU (genitourinary) physician.

Review of SP#5 discharge instructions dated 4/16/15 showed a referral to the primary care physician and to visit the hospital for any emergencies. The referral to the [Named] genitourinary physician was not written as ordered by the physician, and there was no further follow up instructions for a cardiologist.

On 9/15/15 at 12:00 PM, the Director of Case Management and Social Worker stated that SP#5 had [named] insurance provider which had to be coordinated through the PCP (Primary Care Physician), their capitated office. That SP#5 needs to go back to PCP for referrals. That due to multiple physicians available to the pt. at the [named] insurance provider clinics, so the exact physician is not written in the discharge instructions; that the pt. sees multiple physicians in their managed care clinic.

Review of the facility policy titled: "Discharge Procedures" revised on 05/2015 confirmed above findings. It showed on page 2 of 5 under "re-assessment of discharge needs" - the nurse responsible for the patient will coordinate the process of patient discharge with all disciplines which include but not limited to, providers shall order necessary medical therapy/treatments/follow up to assure continuity of care, treatment and services is maintained, such as: 5. Follow up care/appointments.