Failure to Provide Prescribed Thickened Liquids to Resident with Dysphagia
Penalty
Summary
A deficiency occurred when a resident with a physician-ordered diet of nectar thick liquids and no straws, due to diagnoses including dysphagia, was provided with a clear thin liquid and a straw. The resident's care plan, physician's orders, and Kardex all specified the need for nectar thick liquids and no straw, in accordance with the resident's medical needs and facility policy on therapeutic diets. During an observation, the resident was found in bed with a Styrofoam cup containing thin liquid and a straw within reach. Staff interviews confirmed that the resident should not have received this type of drink and that the nursing assistant responsible did not check the resident's ordered diet before providing the drink. The Director of Nursing acknowledged that the facility failed to provide drinks in the form required to meet the resident's individual needs.