Failure to Reconcile Hospice Diet Documentation With Facility Orders
Penalty
Summary
The deficiency involves the facility’s failure to ensure hospice documentation was reviewed and consistent with facility physician orders and the resident’s plan of care for a hospice patient. The resident was admitted with diagnoses including cerebral atherosclerosis, vascular dementia, anxiety disorder, hypertension, and bipolar disorder, and had severe cognitive impairment per the MDS. The MDS and quarterly nutrition reviews documented that the resident held food in the mouth/cheeks, had residual food after meals, and experienced coughing or choking during meals or when swallowing medications. The physician’s diet order specified a regular diet with mechanical soft texture and honey thick liquids. In contrast, hospice reports documented the resident’s diet as soft/puree with honey thick liquids, and the hospice nurse stated that hospice had diet orders on file for soft/puree and honey thick liquids. The DON reported that when hospice records are sent to the facility, the medical records department receives them and uploads them into the documentation system but does not review the contents. The DON further confirmed that the medical records department was not reviewing hospice records and could not confirm that anyone else was reviewing them. The hospice agreement and facility hospice policy required collaboration and consistency between the hospice plan of care and the facility plan of care, but hospice was documenting an incorrect diet that did not match the facility’s physician orders, and the facility did not have a process in place to review and reconcile these discrepancies.
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