Improper Preparation of Thickened Liquids for Resident With Dysphagia
Penalty
Summary
The deficiency involves the facility’s failure to provide food and drink in a form designed to meet an individual resident’s needs, specifically for a resident with oropharyngeal dysphagia and Alzheimer’s disease. The resident’s MDS documented coughing and choking during meals and when swallowing medications, pain when swallowing, and the need for a mechanically altered diet with changes in texture of food and liquids. The physician’s orders, effective October through December, specified a regular diet with regular texture, mildly thick consistency liquids, and fortified food, and the resident had active care plans for dysphagia and nutritional risk that included providing the diet as ordered and 1:1 assistance when needed. During an observation at lunchtime, the resident was seen receiving a meal tray and drinking water that had been thickened. A nurse brought another glass of water with thickener added, but the thickener had visibly settled at the bottom of the glass, leaving the water on top thinner than ordered. When the resident drank the liquid, he began coughing and choking and required assistance to be positioned upright at a 90-degree angle and leaned forward, and the nurse was called. In interviews, the DON stated that nursing staff are permitted to add thickener but that the process requires a few minutes for the liquid to reach the proper consistency, and the LN acknowledged adding thickener to the resident’s water without allowing sufficient time for it to thicken properly. This was inconsistent with the facility’s Diet and Nutritional Care Manual guidelines for serving thickened liquids and the ordered mildly thick (IDDSI Level 2) consistency.
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