Failure to Implement Dietician Recommendations for Tube Feeding
Penalty
Summary
The facility failed to implement the registered dietician's recommendations for a resident who was dependent on tube feedings for all nutrition and hydration needs. The resident had multiple diagnoses, including acute and chronic respiratory failure with hypoxia, hemiplegia, cerebral infarction, dysphagia, and Raynaud's syndrome, and was noted to have a low BMI and significant weight loss over a short period. The dietician recommended a specific tube feeding regimen (Osmolite 1.5cal at 60ml/hr for 20 hours daily) and the addition of liquid protein twice daily. However, these recommendations were not initiated, and the resident continued to receive continuous feedings over 24 hours without the prescribed liquid protein supplement. Interviews with staff revealed a lack of clarity and follow-through regarding the process for implementing dietician recommendations. The LPN stated that dietary recommendations are typically acted upon by earlier shifts and that it is standard practice to obtain physician orders for such recommendations promptly. The DON indicated that recommendations should be implemented within 24 hours but was unsure if this occurred in practice. The facility was unable to provide a policy regarding the implementation of dietician recommendations, and as of the time of the survey, the recommended changes had not been made to the resident's care.