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Based on a review of Medical Staff Bylaws, policies and procedures, medical record, and interview, it was determined the Medical Staff was not accountable to the Governing Body, as evidence by a physician not:

1) identifying a potential nutritional risk, with a diagnosis of diverticulitis, so that Nutritional Services could have been ordered to provide diet education to Patient #1; and

2) ordering a referral to Nutritional Services, with a minimum of 24 hours notice prior to discharge, so that discharge diet education be provided to Patient #1.

Findings include:

1) The Medical Staff Bylaws require: "...Basic Obligation Of Individual Staff Membership...Abide by the...Bylaws, Department Rules and Regulations...and all standards and policies of the...Medical Center...."

The policy "Food and Nutrition: Nutrition Risk Assessment and Intervention" requires: "...identify patients at risk and provide early intervention...Patient may...be identified by...physician referral...if changes in condition may put them at risk...."
On 12/04/10, at 1047, the hospitalist documented the patient had diverticulitis with perforation, no drainable abscess on repeat CT.
The patient had nothing by mouth (NPO) from admission on 12/03/10, until 12/05/10, at 1048, when the surgeon ordered Patient #1, to have clear liquids, and the patient tolerated 100% of the fluids.
On 12/06/10, at 0830, the surgeon examined the patient, and determined patient had an acute diverticulitis with a contained perforation that won't need surgery, was tolerating clear liquids, could advance the diet, and anticipate discharge "tomorrow" (12/07/10).
The nursing staff charted Patient #1, had a snack of oatmeal at 12/06/10, at 0900, and at 1300, ate 90% of a regular meal.
An order for Nutritional Services referral for Patient #1, because "patient would like diet information on diverticulitis," was written by the RN on 12/07/10, at 0140.
The patient was discharged home on 12/07/10, at 1745. The referral was written 6 hours before discharge.
On 09/29/11, the Dietician confirmed the physician did not identify Patient #1's possible nutritional risk and order Nutritional Services personnel to provide nutritional education and review Patient #1's dietetic needs, when on 12/06/10, the patient was identified with a diagnosis of diverticulitis, and a contained perforation, eating a regular diet, and was possibly going home on 12/07/10.
2) The hospital policy "Patient Diet Instruction: Food and Nutrition Services" requires: "...Patients who will be discharged on modified diets will receive education or review of diet and written materials needed for compliance as...deemed necessary...A minimum of 24 hours notice is recommended for discharge diet instructions...."
On 12/07/11, at 0940, the nurse documented, "spoke with patient about avoiding fiber and knowing what foods to avoid for diverticulitis (listen to his body and what he can tolerate) and also made sure there was a nutrition consult and ...prior to discharge."
Discharge instructions were signed by Patient #1, on 12/07/10, with no other diet instructions provided by nursing.
On 09/29/11, the Dietician confirmed the physician did not order Patient #1's modified diet education, with a minimum of 24 hours notice, so Patient #1 could receive discharge diet instructions.

Based on a review of policies and procedures, medical record, and interview, it was determined the nurse executive failed to require a Registered Nurse (RN) document the written education material provided to Patient #1, following an insertion of a peripherally inserted central catheter (PICC).

Findings include:

The hospital policy "Insertion of peripherally inserted central catheter (PICC) for Adult Patients" requires: "...Document:...Patient's response to the procedure and education...."

On 12/06/10, at 1042, the Infectious Disease (ID) physician note's revealed: "...Impression: Acute perforated diverticulitis...will arrange home health with IV Zosyn for 2 weeks, and PICC line...."

The physician's order for Patient #1 to have an insertion of a PICC, was transcribed by a RN as a verbal order, on 12/06/10, at 1551.

A PICC line was inserted by a RN, into the right basilic vein, on 12/06/10, at 1731, with the RN documenting "patent, good blood return, flushes well."

On 09/29/11, the Director of the PICC Team confirmed education regarding care and maintenance of a PICC line is the responsibility of the RN inserting the line, and a booklet that comes with the PICC kit, is part of the patient's education. The booklet includes information on keeping the PICC line dry and to watch for signs of infection.

She stated the RN is to document in the medical record the patient's response to the PICC line insertion and any education provided.

On 09/29/11, after reviewing the medical record, the Director of the PICC Team confirmed the RN who performed PICC line insertion, did not document Patient #1 was given educational material.

Based on a review of policies and procedures, medical record, and interview, it was determined the administrator failed to require Nutritional Services personnel document nutritional written education material was given to Patient #1.

Findings include:

The hospital policy "Patient Diet Instruction: Food and Nutrition Services" requires, "...Document: Nutritional education material provided...."

On 12/07/10, at 1313, a diet technician from Nutritional Services documented in Patient #1's medical record, "diet/nutrition" education for "diverticulitis." The diet technician recommended a "low fiber diet" as part of his discharge.

On 09/29/11, the Registered Dietician stated when dietary personnel provide patients with diet education, they are also provided with written material, obtained from the Department's dietetic manual. She stated from the manual, copies can be made of modified diets, foods to recommend, and to avoid.

She confirmed the manual has a Low Fiber Nutritional diet used by patient's with diverticulitis.

The Registered Dietician confirmed the diet technician did not document what written education material was given to Patient #1.