§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 clinical record review and staff interview, it was determined that the facility failed to implement nutritional interventions to ensure that residents maintained stable weight and reassess weight status for six of 13 sampled residents. (Resident 2, 27, 42, 43, 45, 50)
Findings include:
Clinical record review revealed that Resident 2 had diagnoses that included acute respiratory failure, gastrostomy, cerebral infarct and vegetative state. A Minimum Data Set (MDS) assessment dated May 28, 2019, identified that the resident was severely impaired, was provided enteral feeding and had weight gain. Documentation revealed that on June 13, 2019, the resident weighed 182.9 pounds and on June 25, 2019, the resident weighed 198.5 pounds, a gain of 15.6 pounds. On July 16, 2019, the resident weighed 181.2 pounds and on July 23, 2019, the resident weighed 215.6 pounds, a gain of 34.4 pounds. There was no documentation that the dietitian or the physician had been notified to assess if the gain was accurate and there was no evidence to support that a reweigh was completed.
Clinical record review revealed that Resident 27 had diagnoses that included traumatic brain dysfunction, anemia, Diabetes Mellitus, hyperlipidemia, nutritional Deficiency, and respiratory failure. A Minimum Data Set (MDS) assessment dated July 8, 2019, identified that the resident was provided with a therapeutic diet and enteral feeding. Documentation revealed that on July 15, 2019, the resident weighed 215.4 pounds and on August 14, 2019, the resident weighed 182 pounds, a loss of 15.5 pounds. There was no documentation that the dietitian or the physician had been notified to assess the gain was accurate, and there was no evidence to support that a reweigh was completed.
Clinical record review revealed that Resident 42 had diagnoses that included traumatic brain injury, gastrostomy, chronic respiratory failure, and quadriplegia. The MDS assessment dated August 7, 2019, identified that the resident was severely impaired, was provided enteral feeding and had weight loss not prescribed by the physician. Documentation revealed that on August 9, 2019, the resident weighed 195 pounds and on September 3, 2019, the resident weighed 185.6 pounds, a loss of 9.4 pounds. On May 10, 2019, the resident weighed 214.6 pounds and on June 5, 2019, the resident weighed 200.8 pounds, a loss of 13.8 pounds. There was no documentation that the dietitian or the physician had been notified to assess if the loss was accurate and there was no evidence to support that a reweigh had been completed.
Clinical record review revealed that Resident 43 had diagnoses that included chronic respiratory failure, hyperglycemia, acute kidney failure, anemia, nutritional deficiency, Diabetes Mellitus, and dysphagia. A Minimum Data Set (MDS) assessment dated August 15, 2019, identified that the resident was provided with a therapeutic diet and enteral feeding. Documentation revealed that on September 2, 2019, the resident weighed 140.3 pounds and on March 1, 2019, the resident weighed 157.4 pounds, a gain of 17.1 pounds. There was no documentation that the dietitian or the physician had been notified to assess if the gain was accurate and there was no evidence to support that a reweigh was completed.
Clinical record review revealed that Resident 45 had diagnoses that included chronic respiratory failure, dysphagia, Diabetes Mellitus, and disorders of phosphorus metabolism. A Minimum Data Set (MDS) assessment dated August 18, 2019, identified that the resident was provided with an therapeutic diet and enteral feeding. Documentation revealed that on July 2, 2019, the resident weighed 169.2 pounds and on August 23, 2019, the resident weighed 155.7 pounds, a loss of 13.5 pounds. There was no documentation that the dietitian or the physician had been notified to assess if the gain was accurate and there was no evidence to support that a reweigh was completed.
Clinical record review revealed that Resident 50 had diagnoses that included chronic respiratory failure, nutritional deficiency, pressure ulcer, dysphagia, end stage renal disease, Gastro-esophageal reflux disease, and hyperlipidemia. A Minimum Data Set (MDS) assessment dated August 19, 2019, identified that the resident was provided an enteral feeding. Documentation revealed that on February 12, 2019, the resident weighed 211.8 pounds and on August 9, 2019, the resident weighed 187.4 pounds, a loss of 24.4 pounds. There was no documentation that the dietitian or the physician had been notified to assess if the gain was accurate and there was no evidence to support that a reweigh was completed.
In an interview on September 6, 2019, at 10:30 a.m., the Director of Nursing stated that the reweighs had not been completed.
28 Pa. Code 211.12(d)(3) Nursing services
| | Plan of Correction - To be completed: 10/31/2019
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Preparation and/or execution of this plan of correction does not constitute an admission or agreement by the provider of the truth of the facts alleged or conclusions set forth in the statement of deficiencies. The plan of correction is prepared and/or executed solely because it is required by the provisions of Federal and State Law. The plan of correction represents the facility's credible allegation of compliance.
One, actions taken for situation identified:
1. The facility recognizes that it cannot retroactively correct the situation for residents R2, R27, R42, R43, R45 and R50
2. The Physician and Dietitian were notified of the identified weight changes and have evaluated each of the identified residents for changes in their plan of care
Two, how the facility will respond regarding residents in similar situations:
The facility recognizes that all residents have the potential to be affected. Please see sections three and four for system changes and monitoring mechanisms.
Three, system changes and measures that will be taken:
1. Director of Nursing will provide in-servicing to all clinical staff on Fox Subacute' s weight policy, including re-weighing residents, and notifying the Physician and Dietitian of unplanned weight changes according to policy
2. IDC Team will review morning report for any documented weight discrepancies and timely notification of Physician and Dietitian
Four, monitoring mechanism to assure compliance:
1. The Director of Nursing or his designee will monitor randomly weekly for 4 weeks and then monthly for 3 months for compliance
2. The Director of Nursing will report findings at Continuous Quality Improvement Committee meetings
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