Failure to Ensure Trained Feeding Assistance, Pre-Op Instructions, and Timely Hospital Transfer
Penalty
Summary
The deficiency involves the facility’s failure to provide treatment and care in accordance with professional standards and physician orders for multiple residents. One resident with Parkinson’s disease, dysphagia, GERD, and protein-calorie malnutrition was care planned for an easy-to-chew diet with feeding assistance and had physician orders for medications to be given whole in applesauce or pudding. Activities documentation showed that activities staff fed this resident various desserts and snacks on multiple dates. The Activities Director stated that activities staff provided one-to-one support and feeding assistance and had received general feeding-assistance training. However, the Speech Pathologist reported that the resident had oral dysphagia and that a physician-ordered full swallowing evaluation from March of the prior year was never completed. The Speech Pathologist and the DON both confirmed that non-clinical staff assisting with feeding residents with dysphagia should have specialized training and competency validation, which the activities staff did not have. Another deficiency occurred when a resident with a diagnosis of rotator cuff injury and chronic pain was scheduled for shoulder surgery. The EHR contained a physician order for the surgery appointment, but there was no documentation of pre-operative instructions or that the resident had been educated on those instructions. The resident reported that the surgery could not be performed because he had eaten beforehand and stated that staff had not informed him of any pre-operative requirements. The DON confirmed that pre-operative NPO instructions had been received and were expected to be entered into the EHR and explained to the resident, but acknowledged that neither the instructions nor documentation of education were present in the record. A further deficiency involved a resident who experienced a witnessed fall and subsequently had persistent pain. Nursing progress notes documented a fall with immediate complaints of pain to the lower back, right leg and hip, and left arm. The provider was notified and orders were obtained for pain medication, labs, and x-rays, with initial imaging reportedly negative for acute injury. The resident continued to complain of pain, and a second x-ray several days later revealed a right femur fracture, after which the resident was sent to the emergency department. The DON and the NP both stated that the resident was not sent to the ER immediately after the fall and confirmed that residents with significant injuries such as a femur fracture should be sent to the hospital immediately.
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