§483.25(g) Assisted nutrition and hydration.
(Includes naso-gastric and gastrostomy tubes, both percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy, and enteral fluids). Based on a resident's comprehensive assessment, the facility must ensure that a resident-
§483.25(g)(1) Maintains acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition demonstrates that this is not possible or resident preferences indicate otherwise;
§483.25(g)(2) Is offered sufficient fluid intake to maintain proper hydration and health;
§483.25(g)(3) Is offered a therapeutic diet when there is a nutritional problem and the health care provider orders a therapeutic diet.
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Observations:
Based on facility policy, clinical record review, and staff interview, it was determined that the facility failed to obtain and monitor weights for two of three residents reviewed for nutrition (Residents 3 and 4).
Findings include:
Review of facility policy "Weight Policy" revised December 2022 revealed that each resident will be weighed monthly. "Any resident displaying a significant change in weight of greater than or equal to 5%, gain/loss in one month will be reported to the Registered Dietitian and reweighed. The Registered Dietitian will review the medical record of residents with significant weight changes (i.e. 5% loss/gain in one month, 7.5% loss/gain in 3 months, 10% loss/gain in 6 months). Dietary interventions will be recommended as needed."
Review of Resident 3's clinical record revealed a weight of 227.3 pounds on December 29, 2023 and 227.3 pounds on January 10, 2024. Weight obtained on February 27, 2024, was 192.6 pounds (loss of 34.7 pounds or 15.3% in one month) with no reweigh obtained. Review of the weights and vitals summary revealed a weight of 188.4 pounds on March 11, 2024 (loss of 38.9 pounds or 17.1% in three months) with no reweigh obtained. Further review of the clinical record revealed no evidence that the Registered Dietitian reviewed the record due to the significant weight loss.
Review of Resident 4's clinical record revealed a weight of 167.2 pounds on January 5, 2024 and 150.6 pounds on February 2, 2024 (loss of 16.9 pounds or 10.1% in one month) with no reweigh obtained. Further review of the clinical record revealed no evidence that the Registered Dietitian reviewed the record due to the significant weight loss.
Interview with the Registered Dietitian on March 26, 2024, at 2:50 p.m. indicated that monthly weights are to obtained by the 9th of the month and then reweighs are requested. The Registered Dietitian confirmed that reweighs should have been obtained for Residents 3 and 4.
483.25 F692 Nutrition/Hydration Status Maintenance
Previously cited 6/16/23
28 Pa. Code 211.5(f) Clinical Records
Previously cited 2/28/24, 6/15/23
28 Pa. Code 211.10(c) Resident Care Policies
28 Pa. Code 211.12(d)(1)(3)(5) Nursing Services
Previously cited 2/28/24, 6/15/23
| | Plan of Correction - To be completed: 04/17/2024
1) Resident #3 and Resident #4 were reweighed on 3/27/24. The RD was notified of the weight loss, reviewed and the care plan was updated to reflect current nutritional status.
2) An audit was completed of residents with significant weight loss to validate that reweights were completed as indicated and that weights were reviewed with the RD. Variances were addressed and recorded on the audit log.
3) The DON/Designee re-educated nursing leadership on the weight and reweight policy with focus on RD notification.
4) The DON/Designee will complete 5 random audits to validate that residents with significant weight loss were reweighed as indicated and that weights were reviewed with the RD for four weeks and monthly for two months. Variances will be addressed. Audit findings will be submitted to the Quality Assurance Performance Improvement Committee monthly for further review and recommendations as needed. Further audit frequency will be determined based on the outcome of the previously completed audit findings.
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