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Based on medical record review, interview, review of the facility's Ketogenic Diet Initiation in a Pediatric Patient Protocol and Registered Nurse Job Description, the facility failed to obtain weights in accordance with physician orders for two patient (Patient #3 and #7) of 10 medical records reviewed.

Findings include:

The facility's Registered Nurse Job Description (F00165) stated:
Responsibilities:
- Notes and carries out physician and nursing orders.

1. Patient #3 was admitted to the facility on 07/10/20. The medical record for Patient #3 contained the following weight orders:
07/10/20 8:55 PM - Weigh Daily - Discontinued on 08/24/20 at 10:21 AM
08/24/20 at 10:21 AM - Weigh Daily - Discontinued on 09/11/20 at 11:06 AM
09/11/20 at 11:32 AM - Weigh - Discontinued on 09/25/20 at 2:14 PM
09/25/20 at 2:14 PM - Weigh - Remains Active

The medical record of Patient #3 contained the following documented weights and related notes regarding obtaining weights:
07/02/20 63 kg (138 lb 14.2 oz)
08/06/20 - A Consult Progress Note by Staff DDD on 08/06/20 at 2:35 PM stated: Obtain weight today, and if possible daily weights.
08/24/20 - weight decreased to 47.5 kg
09/04/20 48.3 kg (106 lb 7.7 oz)
09/09/20 - has had an overall weight loss during admission will adjust feeds in order to increase calories
09/10/20 46.6 kg (102 lb 11.8 oz)
09/16/20 47.6 KG
09/17/20 47.9 kg (105 lb 9.6 oz)
09/21/20 46.5 kg (102 lb 8.2 oz)
09/24/20 47.9 kg (105 lb 9.6 oz)
09/28/20 47.9 kg (105 lb 9.6 oz)
10/05/20 47.7 kg (105 lb 2.6 oz)
10/12/20 46.2 kg (101 lb 13.6 oz)

The medical record did not contain documented weights from 07/03/20 through 08/23/20, even though there was an active order to obtain daily weights.

Patient #3 began a Ketocal diet on 08/06/20.

The facility's Ketogenic Diet Initiation in a Pediatric Patient Protocol (Version 2, Effective 04/22/15) was reviewed. The protocol stated:
Interventions
- Obtain Daily Weights

2. Patient #7 was admitted to the facility on 09/22/20. The medical record for Patient #7 contained an order on 09/22/20 at 6:10 PM to obtain admission weight and height. The first documented weight for Patient #7 was on 09/29/20 at 8:00 AM.

The findings were shared with Staff AZ and confirmed on 10/19/20 at 2:59 PM.

This deficiency substantiates Substantial Allegation OH00116195