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Based on clinical record review, review of hospital documents and staff interviews, the hospital failed to ensure that the physician responsible for the care of one sampled patient (Patient 1) ordered his therapeutic diet.

Finding:

Patient 1 is a 65 year old male admitted to the hospital on 8/22/11 with a diagnosis including gastric cancer, post subtotal gastrectomy (surgical removal of all or part of the stomach).

He been on NPO (nothing by mouth) diet for approximately for five days after surgery and was progressed to a clear liquid diet on 8/28/11. On 8/29/11 at 9:16 am, there was diet order for Advance diet by an internal medicine physician. There were two other untimed orders on 8/29/11 by a second physician for Advance diet as tolerated and Advance diet. The final reference to diet by the second physician was to discharge home tomorrow evening if tolerate diet. None of these diets were specific as to what diet the patient should have received.

An administrative staff present during the record review explained that when physicians
write non-specific diet orders, the nurses call the physician to clarify such diet orders. Further review of the electronic record did not indicate that clarification for the diet order was obtained by the nurses. However, the patient was ordered a soft diet.

An interview with the nurse responsible for the care of the patient on 8/30/11was conducted at approximately 10:45 am concerning how the patient ' s diet was ordered without a specific diet order from the attending physician. She indicated that as part of her training as a nurse, she is able to make determination as to what diet a patient should receive.

The physician responsible for the care of the patient failed to prescribe a therapeutic diet for Patient 1. The manner in which the final order had been written, the physician would not have the opportunity to visit the patient prior to his discharge. The patient would have been discharged on the nurse-ordered diet.

The hospital failed to ensure that the practitioner responsible for the care of the patient prescribed also the therapeutic diet.