Failure to Ensure Adequate Tube Feeding and Weight Monitoring for Cognitively Impaired Resident
Penalty
Summary
The deficiency involves the facility’s failure to adequately assess and plan care to ensure that a resident’s tube feeding needs were met, resulting in significant weight loss in less than 30 days. The resident’s admission MDS documented diagnoses of malnutrition, anxiety disorder, and depression, with severe cognitive impairment and NPO status, and indicated that tube feeding provided nutrition. The care plan noted that the resident self-sought food and fluids while NPO, required reminders and redirection due to poor cognition, and had actual alteration in nutrition with weight loss over 30 days related to inadequate caloric intake, evidenced by disconnecting the feeding prior to the end time. A Risk vs. Benefits form completed by the RD stated that the tube feeding met 100% of the resident’s nutrition and hydration needs and that disconnecting the tube feeding prior to the prescribed time could result in continued weight loss, malnutrition, dehydration, return to hospitalization, or possible death. Dietary documentation showed that the RD identified a weight drop from 168 lbs to 155 lbs in less than 30 days, confirmed by reweight, and staff reported that the resident often disconnected the feeding before completion, leading to inadequate caloric intake. Staff also reported that the resident moved frequently in bed, placing the tube at risk of being tugged or pulled. The RD documented that the resident had poor cognition and was difficult to assess for understanding of the risk vs. benefits discussion. The RD re-estimated the resident’s nutritional and fluid needs and recommended a bolus tube feeding regimen with specified formula volumes and water flushes to meet calculated caloric, protein, and fluid requirements, and noted that the provider was notified of the weight loss related to the resident’s noncompliance with the feeding regimen. Weight records in the facility’s electronic system showed multiple entries over the period in question, including an entry that the RD later struck out as incorrect after obtaining a second weight that confirmed 155 lbs. The RD acknowledged that she discovered the weight loss on the same day she learned from staff that the resident was disconnecting the tube feeding, and that she did not speak with the RN about the incorrect weight or re-educate staff on handling incorrect weights. Interviews indicated uncertainty among staff about how long the resident had been disconnecting the tube feeding, and at least one NA reported never seeing the resident disconnect the feeding. The facility’s weight policy required accurate weights and monitoring to ensure residents’ nutritional parameters were maintained, with more frequent monitoring for high-risk residents at the discretion of the interdisciplinary team and/or physician, but the documentation and interviews showed gaps in accurate weight documentation and timely response to the resident’s behavior of disconnecting the tube feeding in the context of significant weight loss.
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