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.

TRISTAR CENTENNIAL MEDICAL CENTER 2300 PATTERSON STREET NASHVILLE, TN 37203 March 7, 2013
VIOLATION: DIETS Tag No: A0630
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Intakes: TN 063

Based on policy review, medical record review and interview, it was determined the facility failed to ensure the nutritional needs of 1 of 5 (Patient #3) sampled patients were met.

The findings included:

1. Review of the facility's "NUTRITIONAL ASSESSMENT BY METABOLIC SUPPORT SERVICE" policy revealed, "...PURPOSE: To provide guidelines for evaluation of the patient's nutritional status prior to the initiation of appropriate nutritional support and to provide information as to the effectiveness of nutritional therapy...Indications for Nutritional Support...Nutritional support should be instituted to prevent the development of protein-calorie malnutirition or as soon as the diagnosis is made...Protein-calorie malnutrition should be suspected and nutritional support provided when any of the following are present...Somatic wasting, e.g. [for example]; pressure sores or a cachetic state..."

2. Medical record review for Patient #3 revealed an admission date of [DATE] with diagnoses of Alzheimer's Disease, Suicidal Ideation, Dementia in Conditions with Behavioral Disturbances, Psychosis, Hypertension, Vitamin D Deficiency, Esophageal Reflux, Osteoporosis, Hypopotassemia, and Iron Deficient Anemia.
The "Sign-in Sheet for Emergency Services" dated 12/20/12 documented, "...CURRENT SYMPTOMS...Unexplained weight loss [circled]..."
The "PSYCH [psychiatric] ADMISSION ASSESSMENT" dated 12/21/12 documented, "...General appearance...SLENDER...UNDERNOURISHED..."
The "NUTRITION INITIAL SCREEN/ASMNT [assessment]" dated 12/21/12 documented, "...Nutrition Plan: NOTIFY RD [Registered Dietician] IF RISK CHG [change]...MONITOR NUTRITION STATUS..."
The "PSY [psychiatric]: TREATMENT PLAN - REVIEW" dated 12/21/12 documented, "...PROBLEM: Nutritional Status, Altered..."
The "PATIENT CARE INQUIRY" dated 1/9/13 documented, "...Dec [December] 21, 12...Wt [weight] - Lbs [pounds]...116...Jan [January] 03, 13...Wt - Lbs...107...[DATE]...Wt - Lbs...106..."
The "NUTRITION FOLLOW UP/RE-ASSESS" dated 1/3/13 documented, "...Weight Changes...107.5 lbs. (Observed 1/3)...Nutrition Comment: Coontinue [continue] to monitor wt. and intake..."

Patient #3 had a 8.5 pound weight loss (7.3%) from 12/21/12 to 1/3/13. The patient was reassessed, but no new interventions were put in place. The patient continued to lose weight from 1/3/13-1/6/13 with a 1.5 pound weight loss (total of 8.6% weight loss from 12/21/12-1/6/13) without any new interventions put in place.

3. During an interview in the conference room on 3/4/13 at 3:30 PM, when asked how the facility addresses a patient's nutritional status, the Vice-President of Quality/Risk Management stated, "...wieghts are done by the techs [technicians]...on Sunday...[staff] chart on each meal...ask families for preferences...[Registered Dietician] looks at weight on the computer..." When asked how the Registered Dietician documents interventions to prevent a patient's weight loss, the Vice-President of Quality/Risk Management stated, "...generally she writes a note..."

4. During a telephone interview on 3/7/13 at 12:40 PM, the Vice-President of Quality/Risk Management confirmed no new interventions were put in place to prevent further weight loss for Patient #3.

5. During a telephone interview on 3/7/13 at 12:43 PM, when asked about Patient #3's weight loss, Nurse #1 stated she believed Patient #3's 12/21/12 recorded weight to be a stated weight. When asked what the facility's policy was for admission weights, Nurse #1 stated, "...we are supposed to wiegh them [patients]..." When asked if the 12/21/12 recorded weight was documented as being a stated weight, Nurse #1 stated, "no."