Failure to Implement Interventions for Weight Loss and Hydration
Penalty
Summary
The deficiency involves the facility’s failure to implement adequate interventions to prevent weight loss and ensure sufficient hydration for a cognitively impaired resident with Alzheimer’s disease, Parkinson’s disease, and depression. The resident’s MDS showed short- and long-term memory problems, severely impaired decision-making, and a need for supervision with eating and drinking, with an initial weight of 230 pounds and no documented weight loss at that time. The care plan identified an ADL self-care performance deficit and included interventions such as staff assistance when the resident was not eating, provision of small frequent meals, house supplements as ordered, RD evaluation for diet changes, and weekly weights. Subsequent weight records showed a progressive decline from 234.5 pounds to 217.4 pounds over several weeks, reaching at least a 5% weight loss, while behavior and health status notes documented repeated refusals of food, supplements, and assistance with feeding, as well as episodes of the resident pushing food away, clamping his mouth shut, and dumping liquids on the floor. Despite these documented behaviors and the ongoing weight loss, the clinical record did not show that appropriate individualized interventions were implemented or adjusted to address the unintended weight loss, as required by the facility’s policy on interventions for unintended weight loss. An after-visit summary later specified that the resident required 2 liters of water per day and 1:1 assistance for water intake and diet orders, but review of the electronic health record showed that from that point forward there was no documentation that the resident actually received 2 liters of water daily. Point-of-care fluid intake records lacked evidence of the ordered hydration, and the DON acknowledged that the record did not document the required 2 liters of water per day or appropriate interventions to prevent further unintended weight loss, in contrast to the facility’s written policy to identify, monitor, and implement individualized interventions for residents with unintended weight loss or malnutrition.
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