HospitalInspections.org

Based on clinical record review and staff interview, it was determined the facility failed to ensure the nursing care rendered to 1 of 3 sampled patients (#1) was adequately supervised and evaluated, to include the provision of care as ordered by the physician and appropriate assessment of the patient's care needs based on the patient's laboratory/diagnostic health status/indicators.

The findings include:

During review of the physician orders for Patient #1, an order dated 02/01/11 documents, Glucerna 50 cc/hr to be administered via GT (Gastric Tube) continuously, 1200 cc in 24 hrs.
Review of the patient ' s Intake/Output record dated 02/02/11 thru 02/14/11, revealed the total
Intake each date was significantly less than the prescribed amount; 02/03/11 = 1020 cc; 02/04/11 = 790; 02/07/11 = 793 cc, and 02/09/11 = 740 cc.
Nutrition evaluation on 2/3/11 notes, "The patient is PEG fed with Glucerna 1.2 adequately at 50 cc/hr. In a subsequent Nutrition Assessment dated 02/08/11 a Registered Dietitian documented, "BUN (Blood Urea Nitrogen) up to 35. On Lasix. Continue poc; will need to add free fluid water flushes eventually.
Review of the patients lab results revealed the BUN had increased from 22 on 02/02/11 to 35 02/08/11 (9-20 is the acceptable range.)
In an interview with a Registered Dietician on 2/15/11 in the afternoon, she stated the patient assessment indicates 1200 cc Glucerna 1.5 in 24 hrs was appropriate, in addition to medication pass water flushes. The dietician concurred the patient's minimum intake should have been 1200 cc/24 hrs plus the fluids given with medications.

At the time of record review, there was no information found or provided to substantiate the interdisciplinary Team/Registered Dietician had assessed and identified risk factors to be managed relating to the patient ' s rising Blood Urea Nitrogen level.