Failure to Provide Physician-Ordered Therapeutic Diet for Diabetic Resident
Penalty
Summary
A deficiency occurred when a resident with multiple diagnoses, including diabetes, malnutrition, anemia, and lactose intolerance, was not provided with a therapeutic diet as ordered by the physician. The physician's order specified a diabetic diet with a 1500ml fluid restriction and lactose intolerance, but the facility did not have a diabetic diet and instead offered a Low Concentrated Sweets (LCS) diet for diabetic residents. The resident's care plan and medical nutrition therapy assessment reflected the need for a diabetic diet, but her meal ticket listed a regular diet, and her lunch tray included items not consistent with a diabetic or lactose-intolerant diet, such as a dinner roll, fried chicken, pineapples in juice, and packets of sugar. Interviews revealed that the dietary and nursing staff were not properly notified or did not clarify the physician's order for a diabetic diet, as the facility did not offer this specific diet. The dietary manager was unaware of the resident's need for a diabetic diet until after the resident reported receiving inappropriate meals. The process for communicating new or changed diet orders involved nursing staff filling out a dietary form and handing it to the dietary manager, but this process failed in this instance, resulting in the resident not receiving the prescribed diet. Further, the dietician responsible for reviewing new admissions did not assess the resident's dietary needs within the expected timeframe, and the facility's policy required nursing to clarify any diet orders not matching the facility's available diets before forwarding them to dietary services. The lack of timely clarification and communication led to the resident receiving meals inconsistent with her medical needs and physician's orders.