Failure to Notify Physician of Change in Condition Due to Meal Refusals
Penalty
Summary
A deficiency occurred when the facility failed to notify a physician regarding a significant change in condition for a resident with multiple complex medical diagnoses, including paraplegia, protein-calorie malnutrition, and several pressure ulcers. The resident had a care plan identifying risk for nutritional status change and poor oral intake, with interventions to encourage and assist with food and fluid consumption. Despite this, the resident refused at least two meals per day on multiple days in March, with documentation showing several instances of consecutive meal refusals and poor intake, but there was no evidence that the physician was notified of these refusals as required by facility policy and the INTERACT Change in Condition tool. The resident's medical record indicated ongoing poor nutritional intake, with an average of 0-25% of meals consumed and multiple days where two or more meals were refused. On specific dates, the resident refused all meals or had five consecutive meal refusals, and fluid intake was also low or refused on some occasions. Staff interviews confirmed that the resident regularly refused meals, and both nurse practitioners interviewed stated they would have wanted to be notified if a resident refused five meals in a row. However, there was no documentation that such notification occurred prior to the resident's acute decline. The deficiency was further evidenced when the resident experienced a significant change in condition, including signs of dehydration, poor skin turgor, sunken eyes, and decreased responsiveness, which ultimately led to hospitalization. Only at this acute stage was the physician notified and action taken. The lack of timely physician notification regarding the resident's ongoing meal refusals and poor intake, as required by policy, contributed to a delay in medical assessment and intervention.