The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

MORRISON COMMUNITY HOSPITAL 303 N JACKSON STREET MORRISON, IL 61270 June 28, 2012
VIOLATION: POLICIES - NUTRITION Tag No: C0279
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on review of Critical Access Hospital (CAH) policy, clinical record review, and staff interview, it was determined, that for 1 of 10 clinical records reviewed (Pt. #1), the CAH failed to ensure the patient was adequately evaluated for nutritional needs.

Findings include:

1. CAH policy, dated 4/10, titled, "Nutritional Assessments" required, "... A nutritional assessment is completed within two weeks by Registered, Licensed Dietitian... a full nutritional assessment will also be completed for patients who have had a significant change in condition..." The policy failed to provide guidance for reassessment when patient's nutritional goals were not met.

2. Pt. #1's clinical record was reviewed and included that Pt. #1 was an [AGE] year old female, admitted to the CAH's swing bed section (room 222) on 12/1/11 from another Hospital, with diagnoses of Spinal Fusion, Right Trochanteric Bursitis, and Chronic Obstructive Pulmonary Disease (COPD), Diastolic Heart Failure, Pleural Effusion, and Pulmonary Hypertension.

Pt. #1's Nursing Admission Database dated 12/1/11 at 1:10 PM included Pt. #1's weight at 150 pounds. Nursing documentation included Pt. #1's weight at 136.4 lbs. By 12/9/11, the day Pt. #1 was discharged to an acute care hospital, Pt. #1 had sustained a 13.6 lb. weight loss in 8 days. On 12/16/11, when Pt. #1 was readmitted from the acute care hospital, Pt. #1's weight was 127.7 lbs., a 11.3 lb. weight loss in 7 days, and was down to 122 lbs. on 1/23/12.

3. A dietary note dated 12/30/11 at 2:42 PM, included a Heart Healthy diet, weight 120 lbs, ideal body weight 100 lbs + or - 10%, and "Inadequate energy intake related to decrease appetite as evidenced by patient stating 'I'm not hungry, I'm nauseated.', recorded intakes of 0 - 25%. Goal: Improved intakes of 50 - 75% most meals. Monitor: Intake record."

4. Pt. #1's intake record from 12/31/11 through 2/1/12 (33 days), included 14 days when the goal of 50 - 75% consumption of most meals was not met. There was no reassessment by the Registered Dietitian.

5. An interview was conducted with the Dietary Director (E #7) on 6/27/12 at 2:55 PM. The Director stated that the Registered Dietician was part time, 16 hours per month, and that the Dietician saw Pt. #1 once on 12/30/11.

6. Pt. #1 was transferred to the Long Term Care Facility within the CAH on 2/2/12 and was transferred to an acute care hospital on [DATE] at 4:00 AM, in a comatose condition. Pt. #1 expired on [DATE].