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Based on record review and interview, the facility's staff failed to ensure the interdisciplinary plan of care for the nutritional status of the patients were monitored and adjusted as indicated. Citing 2 (#1 and #6) of 6 (#1-#6) patient records reviewed. This deficient practice had the likelihood to cause harm to all patients treated in the facility by failure to monitor the nutritional needs of the patients.

Findings:



Review of patient #1's medical record revealed she was admitted on 07/19/2016 at 1900 p.m. The interdisciplinary assessment by the dietician conducted on "07/20/2016 at 1325 p.m. revealed the patient had lost 8.0 % of her body weight over the past month. The Dietician indicated the patient was at moderate risk for nutrition." The patient assessment and plan of care failed to take in consideration the patient had already lost 8% of her body weight during her recent hospital stay and had numerous unhealed wounds and was a hemodialysis patient. According to the facilities own risk assessment the patient should have been at high risk for nutritional problems resulting from non-healing wounds. Review of the skin assessment and the skin photographs indicated the patient had a "large opened abdominal wound, decubitus of the sacral, and abdominal area as well as under the right breast." The interdisciplinary plan was to administer "Nepro Tid" and re-evaluate the patient in 5 to 7 days. Review of the nutritional record from 07/20/2016 revealed the nurse charted "zero amount was eaten at breakfast and lunch" and the staff failed to document the amount eaten at lunch. The dietician assessment completed on 07/20/2016 at 13:25 failed to address the breakfast and lunch amounts eaten that day. On 07/21/2016 the staff documented patient ate "40% at breakfast, zero % at lunch" and failed to monitor or document the intake at dinner. Also, staff failed to indicate the amount of consumption of the Nepro that was ordered tid. On 07/22/2016 the record revealed what appeared to be "5% consumed at breakfast and zero % at lunch". The staff failed to monitor the intake at dinner. The Nepro was documented as given, but it was only documented she consumed "100% of an 8 ounce can " in the evening. On 07/23/2016 the staff documented she "refused breakfast, ate 5% at lunch and zero % at dinner." Also, the record indicated the patient "refused the Nepro". On 07/24/2016 the staff documented patient ate "0% of breakfast, zero % at lunch" and they failed to record her intake at dinner. The record indicated the patient drank "100 % of the Nepro" twice during this day. The third ordered dose of Nepro was not documented. On 07/25/2016 the staff documented the patient ate "25% at breakfast, zero % at lunch" and they failed to document the evening intake. Also, staff documented patient drank "75% of one can of Nepro" on the day shift and there was no recorded amount documented for her consumption of the other two ordered 8 oz. cans of Nepro. On 07/26/2016 the staff documented the patient ate "5% of breakfast, 50% of her lunch, and 20 % at dinner". The amount recorded for the Nepro that was ordered tid was "NA". There was no indication the interdisciplinary plan of care was revised to include additional intervention by the dietician. It wasn't until 07/26/2016 that the physician ordered a calorie count. The family had the patient transported to an emergency room in Beaumont at 2155 (9:55 p.m.) on 07/26/2016. The Emergency room record at the other facility revealed an "IV was started for hydration". The emergency room record revealed "Patient #1 was alert and awake and complaining of pain. "The Emergency physician indicated Patient #1 was "dehydrated and malnourished."

A review of patient #6's medical record revealed the staff failed to include in the plan of care a plan to monitor nutritional intake to promote healing of her skin break down. In addition this patient was a dialysis patients which increases the risk for nutritional deficit. On the plan of care section of the medical record the staff failed to consider the nutritional issues for patients with skin break down and renal disease. The Nursing staff also failed to monitor the nutritional intake by failure to document the evening meal on 06/21/2016 and 06/24/2016. On 06/23/2016 the staff failed to document the consumption of all three meals.
An interview with staff #1 on 10/11/2016 at 3:30 p.m. confirmed the above findings.
A review of the facility's policy titled, "Mid-Jeff: Nutritional Risk Determination" revealed the following:

High Risk criteria
Appetite, poor
Eating <25 % avg intake.
DX
Vented,
HD or PD
CA
Cachexia
Decubitus 3-4
GI obstruction/resection.
F/u 2-3 days.

Moderate
Appetite moderate
Use Judgment
Mod loss 3 or more areas
Follow up q 5-7 days" (SIC)