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Record reviews, staff interviews, and review of the policies and procedures for nutritional assessments revealed the Critical Access Hospital (CAH) failed to ensure a comprehensive assessment was completed by a Registered Dietitian upon admission for Patient 6. The CAH is licensed for 23 beds and had a census of 11 acute care inpatients and 4 Swingbed patients upon entrance. Findings are:

A. Record review on 12/27/10 at 10:00 AM for Patient 6 revealed an acute inpatient admission date of 12/23/10 with pertinent diagnoses of weakness, dry heaving, loose stools, failure to thrive, fatigue, loss of 9 pounds in the last 2 weeks, and altered skin integrity. Weight upon admission was 96.30 pounds with admission plans to "see what can be done to increase oral intake, diet as tolerated, intake and output measurements, Foley catheter, daily weights, and Resource 4 ounces QID (4 times per day). On 12/24/10 Patient 6 required 2 units of PRBCs (packed red blood cells) for anemia. On 12/27/10 Patient 6 was transferred to Swingbed status.

B. Review of the Nutritional Assessment policies and procedures reads:
1. Patients will be evaluated under nutrition risk screen portion of the Admission Nursing Assessment in Clinical Care Station. If any findings under the nutrition risk screening is selected, a request for a consult will be created in Order Management. This creates a request that prints at the nursing station and is sent to the dietary department.
2. The consulting dietitian will evaluate the patient and communicate the nutritional assessment in the dietary tab in the ancillary assessment in Clinical Care Section.
3. A physician must order all nutritional therapy.

C. Interview with the Director of Nursing (DON) on 12/28/10 at 11:30 AM revealed the CAH does have a Registered Dietitian that services the CAH once a week and on a PRN basis, and that the admission nurse did not fill out the computerized assessment properly alerting dietary of the need for an assessment, and it did not get done.