Failure to Provide Physician-Ordered Therapeutic Diabetic Diet
Penalty
Summary
A deficiency occurred when the facility failed to ensure that a therapeutic diabetic diet was prescribed and provided to a resident with type 2 diabetes mellitus, noninfective gastroenteritis and colitis, and gastrointestinal hemorrhage. The resident, who had severely impaired cognition and required assistance with eating, was admitted with a history of diabetes and had care plan interventions indicating the need for a diabetic diet and small, frequent meals. However, the electronic health record and care plan did not reflect an order for a therapeutic diet, and the nutrition assessment did not address the resident's diabetes or the need for small, frequent meals. Despite elevated HGBA1C levels documented in the resident's record, family members' concerns about uncontrolled blood sugars, and requests for a diabetic diet, facility staff—including the ADON and LVNs—communicated to the family that a diabetic diet was not available. The dietary manager and registered dietitian were not made aware of the need for a diabetic diet or small, frequent meals, and no diet order was provided to the kitchen. The registered dietitian had not assessed the resident, as the resident had not triggered for assessment based on the facility's criteria. The attending physician was not informed of the family's request for a diabetic diet and only became aware after state surveyor intervention. The physician stated that he would have ordered a diabetic diet if he had been informed. The facility's own policy required physician orders for therapeutic diets and consultation with the registered dietitian, but these procedures were not followed, resulting in the resident not receiving the prescribed therapeutic diet.