Failure to Implement RNA Feeding Program as Ordered
Penalty
Summary
A deficiency occurred when the facility failed to implement physician orders for a Restorative Nursing Aide (RNA) feeding program for both breakfast and lunch for a resident at risk for dehydration and malnutrition. The resident, who had multiple diagnoses including chronic kidney disease, Alzheimer's disease, anemia, myelodysplastic syndrome, and muscle wasting, experienced significant unplanned weight loss over a three-month period. The resident's care plan and physician orders specifically required RNA assistance with feeding at both breakfast and lunch to address poor oral intake and nutritional risk. Despite these orders, observations and interviews revealed that the RNA feeding program was only provided at breakfast, with Certified Nursing Assistants (CNAs) feeding the resident at lunch instead of RNAs. Staff interviews confirmed that RNAs were not assigned to feed the resident during lunch, and that this practice was not in accordance with the physician's orders or the resident's care plan. Documentation from multiple care conferences and progress notes indicated ongoing poor oral intake and continued weight loss, but did not address whether the RNA feeding program was being fully implemented as ordered. The facility's own policies required that physician orders be accurately transcribed and implemented, and that restorative nursing services be individualized and resident-centered as outlined in the care plan. However, the failure to provide RNA feeding at both prescribed meals resulted in the resident experiencing a 9.4% weight loss over three months, with weights dropping from 82.8 lbs to 75 lbs. Staff acknowledged that not following the physician orders could negatively affect the resident's nutritional status.