Failure to Provide Physician-Ordered Nutritional Supplement
Penalty
Summary
A deficiency occurred when the facility failed to provide a physician-ordered nutritional supplement to a resident with a history of significant weight loss and malnutrition. The resident, who had diagnoses of malignant neoplasm of the right lower lung and small cell B-cell lymphoma, was prescribed a 237 ml bottle of a nutritional supplement three times daily due to poor intake and a documented 10-pound weight loss in one month. Despite this order, the resident reported only occasionally receiving the supplement, and nursing documentation confirmed that the supplement was not available to be given as ordered on multiple occasions. The resident was observed to be thin with visible bony prominences, and her weight continued to decline over several months. The facility's staff, including an LPN and the ancillary clerk responsible for ordering supplies, confirmed that the ordered supplement had been out of stock since the previous day and that no alternative supplement was provided because there was no physician's order for a substitute. The storage room contained other nutritional supplements, but none matching the resident's order. There was no documented communication with the physician or dietitian to obtain an alternative order during the period the supplement was unavailable. The DON stated that nurses should contact the physician for an alternative if a supplement is unavailable, but this was not done in this case.