Failure to Follow Ordered Minced and Moist Diet Leads to Repeated Choking Episodes
Penalty
Summary
The deficiency involves the facility’s failure to ensure that food was prepared and provided in a form consistent with an individual resident’s ordered diet texture and swallowing needs. The resident had diagnoses including cerebral palsy and esophageal obstruction and was care planned and ordered for a mechanically altered, minced and moist diet with aspiration precautions due to swallowing problems. The physician’s order specified a regular diet with minced and moist texture, and the care plan described this as soft, moist foods that are easy to swallow and require minimal chewing. Despite these orders, the resident experienced multiple choking episodes. A progress note documented that during one lunch, the resident choked in the dining room, became slightly cyanotic, had difficulty breathing, was foaming at the mouth, and required multiple Heimlich maneuvers until a large chunk of pineapple was expelled. On another occasion, a visitor reported the resident was choking, with the resident putting fingers in the mouth; Heimlich maneuvers, back blows, and finger sweeps were performed until chocolate was extracted, and a scrape and redness on the resident’s stomach were noted related to the Heimlich. On a later date, during a meal in the main dining room, staff and another resident observed the resident in distress, waving hands and shaking the head, and someone indicated the resident might be choking. A CNA initiated the Heimlich maneuver and ultimately dislodged a piece of grilled cheese sandwich. The CNA stated the resident’s diet order was for soft and bite-sized food and that the resident would not normally receive a sandwich, but believed the sandwich was given because the resident requested it. The cook confirmed the resident’s diet was minced and moist, with breads to be pureed, and acknowledged that a grilled cheese sandwich was not appropriate for that diet. The cook reported asking the dietary manager if the resident could have the grilled cheese sandwich and being told yes, and the dietary manager confirmed she gave that approval while aware of the resident’s minced and moist diet order.
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