Failure to Provide Physician-Ordered Renal Diet
Penalty
Summary
A deficiency occurred when a resident with end stage renal disease, congestive heart failure, and diabetes mellitus, who was prescribed a renal diet with low concentrated sugar and a fluid restriction, was not provided with the specified foods according to physician's orders. Medical record review and meal ticket documentation indicated the resident was to receive limited amounts of juice and milk, as well as a low concentrated sugar diet. However, observations revealed the resident was served and consumed six ounces of orange juice and eight ounces of milk at breakfast, exceeding the prescribed limits. The resident also received and consumed regular sugar syrup instead of the required sugar-free syrup. Interviews with the resident, dietary manager, and registered nurse unit manager confirmed that the resident was not provided with the correct diet as ordered. The dietary manager acknowledged that both the CNA and kitchen staff made errors in serving the incorrect items. The resident was unaware of the dietary restrictions and consistently received and consumed the wrong items. Facility policy required therapeutic diets to be prescribed by the physician to support the resident's treatment plan, but this was not followed in this instance.