Failure to Provide Physician-Ordered Therapeutic Diet
Penalty
Summary
A deficiency occurred when a resident with multiple diagnoses, including hypertension, dementia, obesity, and cancer, did not receive a therapeutic diet as ordered by the physician. The resident, who was severely cognitively impaired and totally dependent on staff for eating, had a physician order for a nectar thick liquids and puree diet, with thin liquids and pleasure foods allowed only under staff supervision. Despite these orders, observations on two separate occasions revealed that the resident's family representative fed the resident regular milk from the original carton using a straw, which was not thickened to nectar consistency. The resident exhibited a slight cough after consuming the thin milk, and there was no staff present to supervise or assist with feeding during these meals. Interviews confirmed that the milk provided was not thickened and that fluids from the kitchen were typically thickened into serving glasses, not left in original cartons. The family representative acknowledged feeding the resident thin milk and noted the resident's cough. The registered dietitian verified that the resident should have received nectar thickened milk unless thin liquids were given under staff supervision, which was not the case during the observed incidents. The facility was unable to provide a policy regarding therapeutic diets and fluid consistencies.