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Based on review of hospital policies, medical records and staff interviews, nursing staff failed to evaluate 2 of 7 patients for a dietary consult who had food Allergies and/or Intolerance (#6 and 8)

The findings include:

Review of Nutrition Policy CP.5.01."Initial Assessment and Prioritization" revealed "RN (registered nurse) nutrition screening triggers (Infant, Pediatric, Adolescent and Specific) will identify any criteria that apply to the patient's condition upon admission. Computer generated consults will be directed to the Metabolic Pediatric team for assessment....Preferences: Food Allergies/ Intolerance and /or Cultural or Ethnic Needs..."

1. Open record review for patient record #6 revealed a 9 year old was admitted on 2/18/13 with diagnosis of prolonged Bipolar Affective Disorder and Anxiety Depression. Review of the admission nursing assessment dated 2/18/13 revealed the patient had allergies to Peanuts and Iodine. Review of the assessment "Nutritional History" indicated "None". The nutritional assessment allowed several selections which included "Food Allergies/ Intolerance and /or Cultural or Ethnic Needs" which indicated a need for "Dietitian Consult". Review of the medical record on 2/26/13 revealed no evidence a consult was directed to the Metabolic Pediatric team for assessment. Medical record review on 2/26/13 revealed no evidence that nursing staff had notified dietary of the patient's allergy to Peanuts until 2/26/13 (8 days after admission).

Interview with patient #6 on 2/26/13 at 4:45pm confirmed she had a peanut allergy. The patient indicated the peanut allergy resulted in hives.

Interview with the Registered Nurse on 2/26/13 assigned to this patient confirmed the patient had a Peanut allergy. She had notified dietary of the Peanut allergy on 2/26/13. Interview with Administrative Staff on 2/27/12 at 10:30 am confirmed there was no evidence a consult was directed to the Metabolic Pediatric team for assessment.

2. Closed record review for patient record #8 revealed an 11 year old was admitted on 9/8/12 with diagnosis of Mood Disorder and Aspergers' Disorder. Review of the admission nursing assessment dated 9/8/13 revealed the patient had allergies to Bananas, Lactose, Lettuce, Mushrooms, Seroquel, Tenex and Wheat. Review of the assessment "Nutritional History" indicated "None". The nutritional assessment allowed several selections which included "Food Allergies/Intolerance and /or Cultural or Ethnic Needs" which indicated a need for Dietitian Consult. Review of annotations by nursing staff on 9/17/12 revealed "Dietary sent some foods that were not on his diet. Staff offered to call for proper foods..." Review of the Discharge summary revealed the patient was discharged on 9/20/12. The summary included the physician documentation of the hospital course. The physician documented "___(patient's name) achieved level 2 early in hospitalization; however, often had difficulty with transition, arguing about bedtime and frustration over his heart healthy diet and dietary restrictions due to food allergy." Review of the medical record on 2/26/13 revealed no evidence a consult was directed to the Metabolic Pediatric team for assessment.

Interview with Administrative Staff on 2/27/12 at 11:00 am confirmed there was no evidence a consult was directed to the Metabolic Pediatric team for assessment.

NC00083827