Failure to Monitor Tube Feeding, Weights, and Nutrition-Related Changes
Penalty
Summary
The deficiency involves the facility’s failure to obtain accurate and timely weights, follow dietician recommendations for weekly weights, and communicate nutrition-related issues for a cognitively intact resident with a G-tube, end-stage renal disease on dialysis, oral cancer, and Type 2 diabetes. The resident initially received continuous Nephro tube feeding at 40 ml/hr while NPO, then was hospitalized and later readmitted with orders for an oral diet plus bolus tube feedings four times daily. The dietician assessed the resident and documented that tube feeding provided approximately 88% of estimated caloric needs and recommended weekly weights due to changes in diet and tube feeding orders. However, no admission/readmission weight was obtained upon return, and no weight was documented for the week of the dietician’s assessment, contrary to facility policy and the dietician’s recommendation. Weight records showed a documented weight of 135 lbs early in the month, followed by a later documented weight of 101.4 lbs and then 101 lbs, reflecting a significant weight loss over a short period. The dietician stated she was not notified of these weights when they were first recorded and only discovered the 12/5 weight herself in the electronic record the day before the survey, at which point she requested a reweigh. The dietician also reported that she was not informed of the resident’s refusals or missed bolus tube feedings, even though the progress notes and MAR showed at least one documented refusal and multiple missed feedings without documentation of refusal or notification. The resident reported sometimes not receiving tube feedings when feeling too full and specifically stated that tube feedings were not given as supposed to be over a weekend. The restorative nurse later produced a revised weight report in which previously documented weights were crossed out and replaced with weights obtained from dialysis records, acknowledging that the CNAs’ earlier weights could not be verified and that the facility had been unaware of the dialysis weights until the night before. The nurse practitioner stated she was not notified of the resident’s significant and continued weight loss until the day before her exam, despite expectations that staff notify her promptly of excessive weight changes. Based on the combined original and revised weight records, the resident experienced a significant weight loss over a two-month period. These failures to obtain accurate and timely weights, follow ordered/ recommended monitoring, and notify the dietician and nurse practitioner of refusals, missed feedings, and significant weight loss contributed to the resident sustaining significant weight loss.
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