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Based on medical record review and administrative staff interview the hospital failed to ensure that medical nutrition therapy interventions for 1 patient (Patient 30) was ordered by the physician prior to initiation. Failure to obtain physician orders prior to implementing nutritional interventions may further compromise the medical status of patients.

Findings:

Patient 30 was admitted for back surgery. Medical record review was conducted on 6/28/16 beginning at 2:40 p.m. A history and physical dated 6/22/16 also noted diagnosis including end stage renal disease, obesity and anemia (low level of iron in the blood). Admission diet order dated 6/22/15 was for a renal diet. In a concurrent interview with Administrative Staff H she stated the renal diet restricted the daily protein intake to 60 grams. A comprehensive nutrition assessment, completed by the Registered Dietitian, dated 6/24/16 noted that Patient 30 was at increased nutritional risk due to a poor intake and dialysis (filtering of the blood through a machine to remove the toxins). The Registered Dietitian implemented 2 packages of Beneprotein®. Each packet of Beneprotein contained 6 grams of protein, potentially adding an additional 12 grams to the protein restricted diet. Similarly the RD also added renal nutritional supplements, each of which had an additional 12 grams of protein. There was no physicians ' order for the additional protein supplement.

In a concurrent interview with Administrative Staff H she stated that the RD was recently hired through a registry service. She also stated she was likely unaware of the necessity to obtain physicians ' orders prior to initiation of medical nutrition therapy.