HospitalInspections.org

29362



This STANDARD is not met as evidenced by:

Based on tours/observations, document review
and staff interviews, the hospital failed to ensure
that the Registered Dietician (RD) reviewed the
daily/weekly menus prepared by the Dietary
Manager to specify any additions, substitutions
or deletions to the menus to meet the need of
patients on specially prescribed therapeutic
diets.

Findings:

1. The Facility did not incorporate therapeutic
diets into the patient's menu.

a) The Facility's policy "Dietician Services"
was reviewed on 11/04/13. The policy stated
that the Registered Dietician would develop and
implement therapeutic diets. The Facility did not
follow its policy regarding the role of the
Registered Dietician in developing and
implementing therapeutic diets. The policy also
stated " The Client's menu development and
approval will be the responsibility of the
Registered Dietician(s) and Director of Food and
Nutrition Services and will be reviewed and
signed by the Registered Dietician. " The policy
also stated that the dietician provide in-service
training to the Food Service Department team
related to specialized diets for patients.

b) In an interview on 12/05/13 at 10:55 a.m., the
Nurse Practitioner stated there were many
patients with medical conditions needing
therapeutic diets, however, there were no
therapeutic menus leaving the patients with
inappropriate food choices and monitoring of
nutritional intake. S/he stated that the dietary
assessments are not completed timely.

c) On 12/03/13 at 09:45 a.m., a tour of the
Facility's kitchen was conducted. During the
tour, the Dietary Manager (DM) was interviewed
and stated that only one menu meal is prepared
and the entire meal is "tweaked" for other
dietary needs. The DM stated " the dietician
marks the food choices on the menu". However,
the menus did not indicate amounts of food or
amounts of proteins, sugars or sodium levels
etc. that were to be given to patients with special
dietary needs. There was no evidence
therapeutic menus had been developed or
approved by the Registered Dietician (RD).

d) In an interview on 12/02/13 at 2:10 p.m., the
Registered Dietician (RD) stated that s/he had
only been in the position for two weeks prior to
the survey. S/he confirmed "the same food was
served to all patients and just tweaked for the
diabetic patients; there is no particular diabetic
diet." S/he stated that s/he has not had time to
go over the menus and the Dietary Manager
sets the menu and determined what additions,
deletions or substitutions constituted a specific
therapeutic diet. S/he stated, " I think there
needs to be more options - I guess we could do
a diabetic or renal but I don't think the
modifications would be that different. I am not
here every day."