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Based on policy review, patient menu review and staff interview, it was determined the facility failed to ensure nutritional needs of patients were met related to food/drug interactions and enteral or parenteral nutrition. The failed practice had the potential to affect all patients admitted to the facility who received medications with potential food/drug interactions and all patients admitted to the facility who received enteral or parenteral nutrition. Evidence follows:

A. Review of the Dietary Food and Drug Interaction Policy (Effective 10/14/91) revealed the Pharmacist provided the Dietary Director with food/drug interaction instruction material for patients receiving Coumadin, iron, cortisones, Ciprofloxin, Tetracycline, Phenelzine, Nardil, Tranylcypromine and Parnate. The Dietary Director then educated the patient regarding the food/drug interaction. The policy lacked any reference to modifying the patient's diet while in the facility.
B. Review of patient menus revealed foods which could cause potential food/drug interactions were included on the Patient Menus.
C. Interview with the Dietary Director at 1345 on 06/29/10 confirmed menus for patients receiving the above medications while in the facility were not adjusted to eliminate foods with the potential to cause food/drug interactions .
D. Review of the Dietary Enteral/Parenteral Tube Feedings Policy (No effective date documented) revealed the physician ordered the feedings, commercial formulas were stored and dispensed by the Material Management Department and Parenteral formulas were prepared and dispensed by the Pharmacy Department. The only reference to the Dietary Department stated a qualified dietary employee advised regarding which commercial formulas to stock in the Material Management Department. The policy lacked any reference to how Dietary was made aware of patients receiving enteral or parenteral nutrition or any reference to nutrition assessment recommendations or monitoring of patients on enteral or parenteral nutrition by a qualified dietary employee.
E. Interview with the Dietary Director at 1345 on 06/29/10 revealed she was unaware when patients were on enteral or parenteral nutrition, because the information was not included on the Patient Diet Sheet. Dietary did not assess and make recommendations unless the Registered Dietitian happened to discover the enteral or parenteral nutrition during record review once per month when she was in the facility.