Failure to Provide Breakfast and Sack Lunch to Dialysis Resident Requiring Feeding Assistance
Penalty
Summary
The deficiency involves the facility’s failure to provide care consistent with professional standards for a newly admitted resident with diabetes mellitus and end stage renal disease (ESRD) who required hemodialysis three times weekly. The resident’s admission record showed diagnoses including metabolic encephalopathy, diabetes, and ESRD with dependence on dialysis, and the order recapitulation documented a dialysis schedule on Monday, Wednesday, and Friday at 8:45 a.m., with an 8:00 a.m. pick-up time from the SNF. The resident’s orders also included a need for feeding assistance, and the MDS indicated intact cognitive skills but dependence on staff for all ADLs. On the morning in question, progress notes documented that transportation picked up the resident for dialysis at 8:30 a.m. before the resident had eaten breakfast. The notes further indicated that the dietary supervisor was informed after the resident had already left, and a sack lunch was then prepared and sent to the dialysis center. Interviews with the dietary supervisor and assistant dietary supervisor confirmed that no sack lunch had been prepared or provided to the resident before departure, and that the kitchen had not been informed of the resident’s early dialysis schedule, despite the kitchen opening at 5:00 a.m. daily. Nursing staff interviews corroborated that the resident, who had necrotic hands and required feeding assistance, was not fed prior to pick-up. A registered nurse stated that a CNA reported transportation arrived at 7:30 a.m., the resident had not yet been fed breakfast, and the resident became upset. The RN and ADON both stated that the resident should have received an early breakfast and a prepared sack lunch before leaving for dialysis, and that the admission nurse had failed to notify dietary/kitchen staff of the early dialysis schedule. The ADON stated that without breakfast and a sack lunch, the resident could have experienced hypoglycemia while at the dialysis center. Review of facility policies on nutritional assessment and care of residents with ESRD showed requirements for identifying clinical conditions affecting nutrition and for staff training on the nutritional needs of residents with ESRD.
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