Failure to Provide Ordered Nutritional Interventions and Follow-Up Weights After Significant Weight Loss
Penalty
Summary
The deficiency involves the facility’s failure to provide consistent and comprehensive nutritional management for one resident identified as being at risk for significant weight loss. The resident, who had a history of traumatic brain injury and dementia with agitation and demonstrated poor cognition with short- and long-term memory deficits, required set-up assistance for meals. A quarterly MDS indicated no weight-loss interventions were in place at that time. The resident’s care plan identified risk for significant weight loss related to altered mental status and combative behaviors, with interventions limited to providing diet and weights per physician orders. Physician orders specified a regular diet and weekly weights, with no active orders for nutritional supplements or other interventions to prevent weight loss. Weight records showed a decrease from 162 lbs to 145 lbs between 11/11 and 12/03, representing a 10.49% loss in less than 30 days, with no documented re-weight after the significant loss. A dietary progress note dated 12/06 documented that the resident had experienced significant unintentional weight loss and stated that oral nutritional supplements (Boost 8 oz twice daily) were being used, and that staff were encouraging fluids. However, review of the MAR/TAR from 12/01 through 12/12 showed no evidence that any nutritional supplements were administered during that period. Interviews with an LPN responsible for the resident’s care and the unit manager confirmed they could not find any orders or documentation showing the supplement was provided or that a re-weight was obtained after the documented weight loss, and both indicated the supplement order had not been re-entered after the resident’s hospital readmission. The RD and DON stated their expectations that the resident receive the recommended supplement and that a re-weight be obtained within 24 hours of significant weight loss. The facility’s resident weight policy referenced routine weights to monitor nutritional health, and requested nutritional health policies were not provided to surveyors before survey exit.
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