Failure to Follow Nutrition and Hydration Protocols for Two Residents
Penalty
Summary
The facility failed to meet the nutrition and hydration requirements for two residents, resulting in deficiencies related to significant weight loss and lack of appropriate interventions. For one resident with a gastrostomy tube, the Registered Dietitian (RD) recommended an adjustment to the resident's enteral feeding formula from 1.2 calories per milliliter (ML) to 1.5 calories per ML due to significant weight loss. Despite this recommendation, the resident's orders were not updated, and the resident continued to receive the lower-calorie formula. Multiple staff, including the Licensed Nurse (LN), RD, and Director of Nursing (DON), confirmed that the RD's recommendations were not implemented, leaving the resident at risk for continued weight loss. Another resident experienced significant unplanned weight loss over several weeks, with documented losses exceeding 10% of body weight since admission. The resident was not weighed weekly as required for new admissions and those with significant weight changes. There were gaps in weight documentation, and progress notes did not indicate any attempts to weigh the resident or refusals. The Assistant Director of Nursing (ADON) acknowledged that weekly weights should have been performed and that the RD should have initiated a weekly weight schedule, but this did not occur. Additionally, the resident was prescribed a dietary supplement to be administered daily, with instructions to encourage intake greater than 75%. However, the Medication Administration Record (MAR) did not consistently document the amount consumed, only whether the supplement was given or refused. The RD stated that knowing the exact amount consumed was necessary to assess nutritional intake, and that a weight committee should have been triggered for the resident. Facility policies required comprehensive nutritional assessments and weekly weight monitoring for new admissions and those with significant weight loss, but these procedures were not followed.