Failure to Implement and Monitor Dietary Interventions for Resident with Swallowing Difficulties
Penalty
Summary
A deficiency occurred when the facility failed to identify, implement, monitor, and modify appropriate interventions for a resident who experienced coughing during meals. The resident, who had a history of metabolic encephalopathy, protein-calorie malnutrition, muscle wasting, acute respiratory failure, and dementia, was observed coughing and with watery eyes while eating spaghetti, meatballs, and garlic toast in the dining room. Staff intervened by removing the plate, but the resident's family member reported ongoing concerns about the lack of assistance with eating and stated that the resident was supposed to be on a pureed diet. The facility did not address the family member's concerns, citing a lack of documentation from the hospital regarding the need for assistance. Review of the resident's records revealed multiple changes in diet orders, including regular, pureed, and mechanically soft diets, as well as recommendations for thickened liquids and supervision during meals. Despite these orders and the resident's severe cognitive impairment, there were instances where the resident was served inappropriate food items, such as garlic bread, which were not consistent with her prescribed diet. Staff interviews confirmed that residents on mechanically altered diets should not receive foods with crusts or hard textures, yet the dietary manager admitted to serving garlic bread to all residents due to a lack of bread sticks. The resident was also noted to be non-compliant with her diet, obtaining snacks from vending machines and other residents, and required education and supervision to prevent consumption of unsafe foods. Speech therapy and nursing documentation indicated ongoing issues with swallowing and coughing during meals, with recommendations for diet modifications and supervision. However, there was a lack of consistent follow-up, as the facility did not have a full-time speech therapist, and the results of a hospital-ordered swallow study were not obtained or reviewed. The care plan and progress notes highlighted the need for a mechanically altered diet and close monitoring, but these interventions were not reliably implemented or adjusted in response to the resident's changing needs and observed difficulties during meals.