Failure to Provide Oral Care Results in Oral Thrush for NPO Resident
Penalty
Summary
A deficiency was identified when a resident who was NPO (nothing by mouth) and dependent on staff for oral hygiene did not receive appropriate oral care, resulting in the development of oral thrush. The resident, admitted with diagnoses including muscle wasting, depression, and dysphagia, had a PEG tube for enteral feeding and required substantial to maximal assistance with oral hygiene, as documented in the Minimum Data Set (MDS) and CNA records. Despite this, there were no physician orders, care plan interventions, or Kardex instructions specifying daily mouth care for the resident. Observations revealed the resident's tongue was coated with a caked-on white substance, and the resident reported not recalling staff cleaning their mouth. Interviews with staff, including CNAs and nurses, indicated a lack of clarity and consistency regarding the provision of oral care, with some staff unaware of the need to clean the resident's mouth or tongue, especially in the absence of teeth. Documentation showed that the resident was frequently dependent on staff for oral hygiene, but this care was not consistently provided. Further interviews with nursing leadership confirmed that oral care should be performed daily for NPO residents to prevent conditions such as oral thrush. However, the absence of clear orders and care plan interventions led to the omission of this essential care, resulting in the resident developing oral thrush, as later confirmed by a nurse practitioner and treated with antifungal medication.