Failure to Follow Nectar-Thick Liquid and Pureed Vegetable Orders for Dysphagic Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide diet and liquid consistencies as ordered for a resident with dysphagia and COPD. During a lunch observation, the resident was seen eating mashed potatoes and cooked cabbage that contained various thicknesses of cabbage strands with thin liquid pooling around the edges, rather than the pureed seasoned cabbage specified on the meal ticket for his mechanical altered/ground diet. The meal ticket for that lunch listed a mechanical altered/ground diet with nectar thick liquids and specifically called for pureed seasoned cabbage, but the vegetable served was not pureed. At the same meal, the resident’s tray included a closed container of nectar thick apple juice and, next to the tray, a large bedside pitcher filled about one-third with ice and water. The resident drank the entire container of nectar thick juice at once and then coughed multiple times, and later took a sip from the bedside water pitcher and coughed again. The resident stated that he likes to drink water and that staff put ice in the pitcher and fill it with water. A CNA reported that she had filled the resident’s pitcher with ice and water that morning and confirmed that the water in the pitcher was not thickened. She also stated that CNAs were not allowed to thicken liquids and that only nurses could do so. A nurse confirmed that the resident was on nectar thick liquids due to swallowing problems and risk for aspiration and acknowledged that residents were not allowed to get ice themselves. The registered dietitian stated that kitchen staff should follow the meal ticket, that if the ticket specified pureed cabbage that is what should have been served, and that residents on nectar thick liquids should not have a bedside pitcher of ice and water because ice melts to a thin liquid. The speech language pathologist reported that the resident had been on a mechanical soft diet with nectar thick liquids due to COPD and swallowing discoordination, with prior recommendations for all liquids, including water, to be thickened to nectar consistency and no water pitcher within reach. At the time of the lunch observation, the physician’s order and care plan documented a mechanical soft diet with nectar thick liquids and aspiration precautions, and facility policies required that thickened liquids and therapeutic diets be provided as ordered.
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