Failure to Provide Ordered Honey-Thick Liquids During Activity and Meal Service
Penalty
Summary
The deficiency involves the facility’s failure to provide liquids in the physician-ordered honey-thick consistency for a resident with dysphagia during an activity and meal period. A resident on a mechanical soft diet with honey-thick liquids was observed seated at a table with mechanical soft food items, a closed container of honey-thick milk, an opened container of honey-thick juice, and an opened can of soda. The resident’s meal ticket and electronic health record documented a diet order of mechanical soft/mechanical altered with honey-thick liquids due to swallowing difficulties and a history of stroke and dysphagia. The speech therapy evaluation and plan of treatment also recommended honey-thick liquids. During observation, the activity aide stated that the resident could only drink honey-thickened liquids and acknowledged that the soda in front of the resident was not thickened, explaining that the soda had been requested by the resident but was supposedly not being consumed. Shortly thereafter, the resident was observed picking up the soda can and taking several sips, which was confirmed by both the activity aide and the social worker, who stated the resident should only be drinking honey-thick liquids. The social worker later explained that a family member had donated pizza and soda after a religious service and that a staff member must have provided and opened the soda for the resident, as the resident could not have opened it independently. In interviews, the resident confirmed that all liquids, including water, must be thickened to prevent coughing and stated that a staff member had given and opened the soda without offering to thicken it, adding that she would have accepted thickened soda and believed staff had forgotten to thicken it. The RN verified that the resident was on a mechanical soft diet with honey-thick liquids and at high risk for aspiration, and that thickener was available on the medication cart, but he had not been informed that the resident had been given soda. The activity aide stated she knew the resident required honey-thick liquids and that nursing staff are responsible for thickening beverages, but described the environment as very busy after the religious service and acknowledged placing the soda in front of the resident and that it should not have been opened or consumed unthickened. The speech language pathologist confirmed the need for honey-thick liquids for this resident and stated that all liquids, including soda, can be thickened and that non-honey-thick liquids would place the resident at risk for increased coughing, choking, and aspiration pneumonia. Facility diet lists, meal tickets, and kitchen policies further documented the requirement for thickened liquids and adherence to therapeutic diet orders.
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