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SEASIDE HEALTH SYSTEM 4363 CONVENTION STREET BATON ROUGE, LA 70806 May 12, 2014
VIOLATION: DIETS Tag No: A0630
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on interview and record review, the hospital failed to ensure nutritional needs were met in accordance with orders of the practitioners responsible for the care of the patients as evidenced by 6 (#F1- #F6) of 6 (#F1-#F6) patients reviewed not receiving their 1800 calorie ADA (American Diabetes Association) diets as ordered.

Findings:

Patient #F1
Review of the medical record for Patient #F1 revealed he was admitted on [DATE] with diagnosis which included Schizophrenia and Diabetes mellitus.

Review of the admission order sheet for Patient #F1 dated 4/30/14 at 5:15 p.m. revealed an order for an 1800 calorie ADA diet.

Review of the Dietary Intake and Output Sheets for Patient #F1revealed the following entries:
5/3/14- Morning Snack: Cookies; Evening Snack: Chips
5/4/14- Morning Snack: Cookies
5/5/14- Evening Snack: Cookies
5/6/14: Morning Snack: Chips
5/7/14: Morning Snack: Oreos; Evening Snack: Cookies and Chips
5/8/14: Morning Snack: Shortbread Cookies
5/9/14: Evening Snack: Cookies

In an interview on 5/12/14 at 12:21 p.m. with SF3Dietician said diabetic menus consisted of three meals, an a.m. snack ( choices: SF (Sugar Free) Jello, SF pudding, Crystal Light and/or 3 graham cracker squares) and a bedtime snack ( 1/2 sandwich and/or skim milk ). She confirmed chips, cookies (Oreos, Shortbread) and Chex mix were not appropriate snacks for a 1800 calorie ADA diet.

In an interview with SF2DON on 5/12/14 at 1:50 p.m., he verified the Oreos, Shortbread Cookies and Chips Patient #F1 was being given were not allowed on an ADA diet. SF2DON said, after review of the Dietary Intake and Output Sheets, " So we're giving them the wrong diet and controlling their blood sugar with insulin."

Patient #F2
Review of the medical record for Patient #F2 revealed he was a [AGE] year old male admitted on [DATE] with diagnosis which included Bipolar I Depression severe with psychosis. Further review of the psychiatric evaluation revealed the physician documented the patient had "Hyperglycemia with DM (?)". (Diabetes Mellitus)

Review of a physician's order dated 5/2/14 at 7:50 a.m. for Patient #F2 revealed an order for NCS (no concentrated sweets) for now. In an interview on 5/12/14 at 12:21 with SF3Dietician, she said NCS diet meant the same at the hospital as an 1800 calorie ADA diet.

Review of the Dietary Intake and Output Sheets for Patient #F2 revealed the following entries:
5/2/14- Morning Snack: Carmel Popcorn; Evening Snack: Chips
5/3/14- Morning Snack: Cookies
5/4/14- Morning Snacks: Cookies
5/5/14- Morning Snack: Chips
5/6/14- Lunch: Cake
5/7/14- Morning Snack: Oreo; Dinner Evening Snack: Oreos, Pretzels

In an interview with SF2DON on 5/12/14 at 1:52 p.m., he verified the diet Patient #F2 was being given was not an ADA diet.

Patient #F3
Review of the medical record for Patient #F3 revealed she was admitted on [DATE] with diagnosis which included Schizoaffective disorder and Diabetes mellitus.

Review of the admission order sheet for Patient #F3 dated 5/3/14 at 2:20 a.m. revealed an order for an 1800 calorie ADA diet.

Review of the Dietary Intake and Output Sheets for Patient #F3 revealed the following entries:
5/3/14- Morning Snack: Cookies; Evening Snack: Chips
5/4/14- Morning Snack: Cheese Crackers; Evening Snack: Chips

In an interview with SF2DON on 5/12/14 at 1:52 p.m., he verified the diet for Patient #F3 was not the ADA diet the patient was prescribed because cookies and chips were not diabetic snacks.

Patient #F4
Review of the medical record for Patient #F4 revealed she was admitted on [DATE] with diagnosis which included Depressive Type Psychosis and Diabetes mellitus.

Review of the admission order sheet for Patient #F4 dated 5/3/14 at 11:01 a.m. revealed an order for an 1800 calorie ADA diet.

Review of the Dietary Intake and Output Sheets for Patient #F4revealed the following entries:
5/3/14- Evening Snack: Chips
5/4/14- Morning Snack: Cookies
5/5/14- Morning Snack: Chips; Evening Snack: Chips
5/6/14: Morning Snack: Chex Mix

In an interview with SF2DON on 5/12/14 at 1:53 p.m., he verified the Cookies, Chex mix and Chips Patient #F4 was being given were not allowed on an ADA diet.

Patient #F5
Review of the medical record for Patient #F5 revealed he was a [AGE] year old male admitted on [DATE] with diagnosis which included Schizoaffective Disorder and Diabetes Mellitus.

Review of the Physician's Admission Orders for Patient #F5 dated 5/2/14 at 8:20 p.m. revealed an order for an 1800 calorie ADA diet and a low Sodium Diet.

Review of the Dietary Intake and Output Sheets for Patient #F3 revealed the following entries:
5/2/14- Evening Snack: Chips
5/3/14- Morning Snack: Cookies; Evening Snack: Chips

In an interview on 5/12/14 at 3:30 p.m. with SF2DON, he verified chips and cookies were not part of a diabetic diet.

Patient #F6
Review of the medical record for Patient #F6 revealed she was admitted on [DATE] with diagnosis which included Depression and Diabetes Mellitus.

Review of the admission order sheet for Patient #F6 dated 5/6/14 at 7:00 p.m. revealed an order for an 1800 calorie ADA diet.

Review of the Dietary Intake and Output Sheets for Patient #F6 revealed the following entries:
5/7/14- Evening Snack: Chips
5/8/14- Evening Snack: Chips

In an interview with SF2DON on 5/12/14 at 3:32 p.m., he verified the Chips Patient #F6 was being given were not allowed on an ADA diet.

In an interview on 5/12/14 at 5:30 p.m. with SF7DietaryManager she confirmed chips, cookies (Oreos, Shortbread) and Chex mix were not appropriate snacks for an 1800 calorie ADA diet.