HospitalInspections.org

Based on a review of documentation and interview, the facility failed to ensure that individual patient nutritional needs were met in accordance with recognized dietary practices.

Findings included:

Facility based policy entitled, "NURSING SERVICES POLICY ON HEIGHTS AND WEIGHTS" stated in part,
"2. Height and weight measurements shall be obtained weekly, on Saturdays, on all patients unless ordered more frequently by the attending physician. Weights shall be documented on the graphic sheet of the patient's medical record and in the weekly weights binder.
3. Heights and weights shall be charted in the progress notes if:
A. Measurements are abnormal or indicate significant changes.
B. Patient is on a reduction or weight gaining diet.
C. Patient is on medications that may influence measurements.
D. Patient has a physical condition that may require close monitoring of measurements."

The Patient Weight Record for Patient #1 revealed the following documentation:
09/20/20: 122.8
10/11/20: 67.8 kg 148.1 lbs, bed scale, Justification noted, "Bed error issues".
10/17/20: 64.5 kg 142.5 lbs, bed scale
11/01/20: "Pt refused for wt from bed scale"
11/08/20: "Pt refused weight from bed", Justification noted, "bed reset".
11/14/20: 45.5 kg 100.1 lbs, bed scale, Justification noted, "Bed error (possibly)".
11/29/20: 101.4 lbs, bed scale

Based on the above documentation, the facility failed to ensure that weights were obtained weekly per policy. There were no weights on the following weeks (Saturdays identified per policy): 9/26/20, 10/03/20, 10/24/20, and 12/06/20. There was no weight documented for two weeks in a row (11/01/20 and 11/08/20); it was noted the patient refused the weight, it is unclear how the patient could decline the weight when a bad scale was being used. The abnormal weights were not noted in the progress notes. There was a noted 20 pound increase from September to October and then a possible 40 pound decrease in approximately a month (10/17/20 to 11/14/20). The noted "bed error" for 2 dates had no follow up as to if the issue was reported, the scale re-calibrated, or an alternative weight implement was used to see what the patient's actual true weight was.

An accurate record of patient weight is necessary to effectively track the patient's response to a therapeutic diet. The above findings were verified on 12/20/20 with staff member # 1 and 2.

Based on a review of documentation, the facility failed ensure that therapeutic diets must be ordered by a practitioner responsible for the care of the patient were effectively implemented.

Findings included:

Patient #1 had the following physician nutrition orders in place:
* On 12/06/20 at 0950 "May place NGT if pt eats <50% meals, give 1 ½ cans Glucerna 1.5".
On 12/06/20 nursing documentation for 12/06/20 reflected the patient received Glucerna 1.5 1 ½ can for each meal after eating < 50 %. of each meal.
On 12/07/20 nursing documentation reflected the patient received Glucerna 1.5 1 ½ can for each meal after eating < 50 % of each meal.
On 12/08/20 nursing documentation reflected the patient received Glucerna 1.5 1 can for each meal after eating < 50 % of each meal..
* On 12/09/20 at 1400 "Change Glucerna 1.5 1 ½ cans PT TID. H2O pt 300 cc q 6 hours"
On 12/09/20 nursing documentation for 12/09/20 reflected the patient received Glucerna 1.5 1 can for each meal.

Based on the above documentation, the patient received the appropriate amount of Glucerna per physician orders on 2 of 4 days, only receiving 1 can of Glucerna not 1.5 cans per order.