§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 three of four residents reviewed for nutrition (Residents 12, 36, and 45).
Findings include:
Review of facility policy, "Weight Management/Weight Loss", revised July 12, 2022, revealed that "monthly weights will be taken by qualified staff during the first 5 days of each month and documented in the electronic medical record after being verified by licensed staff. If a +/- 3 lb [pound] discrepancy exists, the resident should be reweighed immediately with nurse verifying weight. If unable to verify immediately reweight will be obtained on the following day." Additionally, if a weight loss/gain of 3 or more pounds is noted, dietitian is to be notified in a timely manner for follow up and recommendations.
Review of Resident 12's clinical record revealed an admission weight of 147.0 pounds on August 28, 2023.
Resident's weight was recorded as 135.8 pounds on January 4, 2024 and 129.4 pounds on February 1, 2024, with a reweight on February 2, 2024 of 127.4 pounds (loss of 8.4 pounds or 6.2% in one month). Further review of the clinical record revealed that a nutrition/dietary progress note on February 26, 2024, (24 days after the reweight was obtained) indicated that the resident triggered on the monthly weight report for significant weight loss. No further recommendations were initiated.
Interview with Employee E3 on March 1, 2024, at 11:15 a.m. revealed that "potentially would expect some intervention to be put into place" due to significant weight loss over one month and progressive weight loss since admission.
Review of Resident 36's clinical record revealed a weight of 99.0 pounds on January 1, 2024, and a weight of 83.8 pounds on February 1, 2024 (loss of 15.2 pounds or 15.4% in one month). Further review revealed that a reweight was not obtained.
Interview with Employee E3 on March 1, 2024, at 11:15 a.m. confirmed that a reweight should have been completed.
Review of Resident 45's clinical record revealed a weight of 204.8 pounds on January 2, 2024, and 188.4 pounds on February 1, 2024( loss of 16.4 pounds or 8.00% in one month). Further review revealed that a reweight was not obtained. Review of nutrition assessment of February 4, 2024, noted significant weight loss.
Interview with Employee E3 on March 1, 2024, at 11:15 a.m. confirmed that a reweight should have been obtained so an accurate assessment could be completed. Employee E3 indicated that a reweight should be obtained for a 5 pound change for a resident over 100 pounds and a 3 pound change for a resident under 100 pounds. A reweight should have been completed within 24 hours.
28 Pa. Code 211.5(f) Clinical Records
28 Pa. Code 211.10(c) Resident Care Policies
28 Pa. Code 211.12(d)(1)(3)(5) Nursing Services
| | Plan of Correction - To be completed: 04/01/2024
Weight policy to be re-evaluated and updated by March 18th, 2024. Staff will be in-serviced regarding updated policy and guidelines regarding weight monitoring by March 27th, 2024. RD will ensure time is set aside for weight monitoring, documentation, and evaluation for need for weight verification.
All residents potentially affected by this practice. Residents identified during survey have had re-weights/monthly weights obtained and nutritional evaluation completed for them.
Weights will be obtained by 7th of the month; RD will identify weight changes and address significant changes within 72 hours of notification. RD will notify family, physician and resident if applicable of changes to plan of care.
Staff will be in-serviced on new policy by March 27th, 2024. Weights will be monitored with exemptions cleared through EMR system by 11th of each month. 25% of resident population will have monthly weights audited to ensure weight accuracy, re-weights obtained per policy and appropriate follow up completed.
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