Failure to Provide Timely Nutrition Assessments and Interdisciplinary Collaboration for Residents with Weight Loss
Penalty
Summary
The facility failed to maintain an adequate food and nutrition department for three residents who experienced significant weight loss. Timely nutrition assessments were not performed after weight loss triggered a change of condition for all three residents. In one case, a nutritional assessment was completed 26 days after severe weight loss was identified, while in another, the assessment was completed 46 days after the trigger. For the third resident, the assessment occurred 77 days after the weight loss was noted. These delays were contrary to the facility's policy, which required prompt nutritional assessments upon a change of condition that placed residents at risk for impaired nutrition. The Registered Dietician (RD) did not participate in weight variance interdisciplinary team (IDT) meetings, nor did the RD document progress notes indicating review of IDT meeting notes. The RD stated that meeting times conflicted with other obligations and was unaware of the expectation to enter weekly progress notes for missed meetings. The Director of Nursing (DON) and Administrator confirmed that the RD had not attended any weight meetings since starting at the facility, and no progress notes were entered for missed meetings. This lack of participation and documentation hindered the collaborative approach required for managing residents with weight loss. Communication and collaboration between the RD and the dietary department were also lacking. The Certified Dietary Manager (CDM) reported no direct communication with the RD regarding residents experiencing weight loss, and the RD confirmed not having spoken to the CDM. Additionally, the RD did not notify the facility of completed assessments or recommendations for the residents in question. Both the RD and the facility's Administrator were unfamiliar with the Agreement to Provide Dietetic Consultation Services contract, which outlined responsibilities such as orientation to facility policies and written notification of significant weight loss. The Administrator admitted not notifying the RD in writing about residents with significant weight loss, and the RD was unaware of the facility's policies.