Failure to Maintain Nutritional Status and Notify Physician/RD of Significant Weight Loss and Tube Feeding Changes
Penalty
Summary
The deficiency involves the facility’s failure to maintain a resident’s nutritional status and follow care plan interventions and policy regarding significant weight changes and treatment alterations. The resident had moderately impaired cognitive skills and diagnoses including myotonic muscular dystrophy, diabetes mellitus, and malnutrition, and was NPO with all nutrition provided via enteral tube feeding. The care plan directed staff to provide the ordered NPO diet, monitor weights, and notify the physician and Dietitian of significant weight changes, and identified that the resident had tube feedings related to gastrostomy status with a goal to tolerate feedings and remain free of complications. An intervention noted that the resident might refuse feedings. The Dietitian’s nutrition assessment documented that the resident’s enteral feeding provided all nutrition and recommended increasing the feeding volume from 240 mL to 250 mL five times per day and increasing water flushes due to the resident being below estimated needs. The MAR for February showed an order for enteral feedings of 250 mL five times daily with water flushes, which was discontinued later in the month. During that period, the resident refused multiple scheduled tube feedings, particularly at the 10:00 AM, 6:00 PM, and 10:00 PM times. Despite these frequent refusals, there was no documented notification to the physician or Dietitian as required by the care plan and as expected by the DON when refusals occurred more than twice. On 2/26, the enteral feeding regimen was reduced to 300 mL twice daily, significantly decreasing the total daily volume, and this order was later discontinued and then restarted in March, without documentation of a physician’s order or indication for the reduction. The resident’s recorded weights showed a decline from 130 pounds in early January to 121.1 pounds in mid-February and 119.5 pounds in late March, representing a significant, unexplained weight loss. The Dietitian reported not being informed of the frequent refusals of tube feedings in February or of the reduction in feedings to twice per day, and could not find an order or indication from the physician for this change. The facility’s policy on Notification for Change in Condition required immediate consultation with the physician and notification of significant changes in status and significant alterations in treatment, but this was not followed in relation to the resident’s weight loss and feeding regimen changes.
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