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It was determined based on interviews and record review the RN failed to ensure the nursing care for 1 of 10 patients (Patient #1) was provided and/or assigned to other nursing personnel to meet (Patient #1's) needs. (Patient #1) was admitted to the hospital 03/16/13 at 02:00 PM. (Patient #1's) continuous tube feeding was not started until 03/16/13 at 20:00 PM.

Findings Included:

(Patient #1's) Clinical Field Evaluation record dated 03/12/13 reflected, "90 year old female...coccyx wound...admitted to....hospital for status post hemiarthroplasty...discharge to...family noticed she had a decrease in appetite, decreased urine output...transferred to ER (emergency room) 03/03/13 for evaluation and workup...revealed right lower lobe pneumonia, pseudomonas urine culture, acute kidney injury...J-feeding...updrafts every eight hours...coccyx unstageable 2 cm (centimeters) by 6 cm with slough, eschar...sero-drainage..."

The Standard Admission Orders dated 03/16/13 timed at 14:40 PM reflected, "Enteral nutrition...peg Optimental at 30 cc (cubic centimeters) per hour...H20 (water) 50 cc every six hours...IV (Intravenous) not continued..."

The narrative notes dated 03/16/13 timed at 14:40 PM reflected, "Assessment done...drowsy...peg tube site benign...Foley catheter in place...16:00 PM...patient repositioned...17:00 PM...visitors at bedside...18:45 PM...report given to on-coming shift..." It was noted no tube feeding and/or care and initiation of the continuous feeding was completed.

The physician's orders dated 03/16/13 timed at 19:45 PM reflected, "Change Optimental to Jevity 1.2 at 60 ml/hr (milliliters per hour)..."

The nursing daily documentation dated 03/16/13 reflected, "20:00 PM...feeding 60 cc per/hour..." It was noted the continuous feeding was started at the above time on the second shift.

On 06/14/13 at 10:40 AM Personnel #6 (Dietitian) was interviewed. Personnel #6 stated the hospital did not carry the Optimental formula ordered for (Patient #1) when she was admitted on the afternoon of 03/16/13. Personnel #6 stated she received a call from the evening nurse that (Patient #1's) ordered formula was not available. Personnel #6 stated she informed the nurse the substitute formula to use. Personnel #6 was asked by the surveyor what would a reasonable time be for starting a continuous tube feeding. Personnel #6 stated within an hour would be appropriate.

On 06/14/13 at 12:30 PM Personnel #4 (RN) was interviewed. Personnel #4 stated she went into the room where the formula ws stored and determined the ordered formula was not available. Personnel #4 stated she was the Charge RN and got busy assisting another RN with a second admission. Personnel #4 stated she did not contact the Dietician about the formula for (Patient #1's) tube feeding nor did she start the tube feeding. Personnel #4 stated she did not ask one of the other nurses to assist her in the care of (Patient #1).

On 06/14/13 at approximately 01:00 PM Personnel #2 was interviewed. The surveyor reviewed the 03/16/13 staffing/assignment schedule for 07:00 AM to 07:00 PM with Personnel #2. The schedule revealed two Registered Nurses, three Licensed Vocational Nurses and two nurse aides. Personnel #2 was asked why the RN did not assign and/or ask one of the other nurses to contact the Dietitian and/or start the continuous tube feeding. Personnel #2 offered no comment.

On 06/14/13 at 08:15 PM Personnel #5 was interviewed. Personnel #5 stated she started (Patient #1's) continuous feeding after she spoke with the Dietitian on the substitute formula to use for (Patient #1).

The policy and procedure entitled, "Dietary Communication" with revision/review date of 07/20/11 reflected, "To develop appropriate channels of communication between nursing and dietary services to enhance patient outcomes...nursing and dietary services will communicate regularly regarding issues of patient nutritional status..."