Resident with Cranberry Allergy Served Allergenic Beverage
Penalty
Summary
A resident with documented allergies to cranberry fruit extract and cranberry juice was served cranapple juice by a Certified Nursing Assistant. The resident consumed the entire cup before realizing it contained cranberry juice. The incident was documented in the resident's electronic health record, and the resident subsequently reported the event to the Office of Health Facility Licensure and Certification. The resident was given a rescue inhaler and Benadryl as a precaution and was monitored, but did not experience any adverse reactions. Interviews with other residents with food allergies indicated they had not received foods to which they were allergic. Nursing Assistants described the process for identifying residents with allergies, which included a list in the pantry and Post-It notes on the drink cart. However, the event involving the resident with a cranberry allergy demonstrated a failure to consistently follow these procedures, resulting in the resident being served an allergenic beverage.