cms_TN: 9112
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| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 9112 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2013-09-11 | 325 | D | 0 | 1 | 3NWZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to prevent weight loss for two residents (#118, #79) of thirty residents reviewed for weight loss. The findings included: Resident #118 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Record review of the Monthly Weight Record revealed a weight of 137 pounds in March 2013. Review of the Certified Dietary Manager's (CDM) Dietary Notes dated May 8, 2013, revealed .Weight showing a trending down x (for) 90 days. Medical record review of the [MEDICAL CONDITION] Medical Management Progress Note dated July 25, 2013, revealed .Long and short term memory impaired, chronic (scored 5 on a scale with 10 indicating the most severe impairment); Recall impaired, chronic with a score of 5; Attention and Judgement impaired; and Appetite - Decreased with a score of 7, Acute . Review of the resident's Care Plan Meeting held on August 7, 2013, revealed the family .concerned .weight. Noted Ensure (liquid dietary supplement) seems to give (resident) diarrhea. Review of the CDM's Dietary Notes dated August 9, 2013, revealed Recommendation placed in MD (doctor) communication book for [MEDICATION NAME] (medication) for increased appetite due to poor intake and weight decline . Record review of the Monthly Weight Record revealed the resident weighed 124 pounds in August 2013. Continued review revealed the September weight was 123 pounds. Observation and interview of the resident on September 10, 2013, at 8:45 a.m., revealed the resident was unable to recall any information about what was served or eaten for breakfast. Interview with the Director of Nurse's (DON), in the DON's office at 4:55 p.m., on September 10, 2013, confirmed the resident had experienced significant weight loss. Interview confirmed the Registered Dietitian (RD) had not provided evaluation or input on the resident's weight loss. Continued interview confirmed the resident's labwork results on May 9, 2013, revealed two nutritional indicators, total protein and [MEDICATION NAME], had below normal values at 5.8 (range 6.0 - 8.5) and 3.2 (range 3.5 - 5.0). Interview confirmed the resident did not have a protein supplement prescribed by the physician after the nutritional indicators were identified as below normal. Interview included a review of the Physician's Progress note dated August 12, 2013, and confirmed the progress note stated trial appetite stimulant and monitor response and confirmed the trial of an appetite stimulant had not been initiated as of September 10, 2013. Continued interview confirmed the Nursing staff had noted the resident frequently had difficulty focusing on a meal and would get up and wander off. Interview revealed the resident had been added to the feeder list and was to be assisted at meals since August 23, 2013. Observation of the resident on September 11, 2013, at 8:25 a.m., revealed the resident was resting in bed and breakfast had not been served. Continued observation revealed the resident had a breakfast tray taken to their room at 9:15 a.m. Interview on September 11, 2013, at 10:10 a.m., with the Certified Nurse Aide (CNA #1) revealed, .usually in bed for breakfast .if you wake up too early gets upset and won't eat anything .will usually take cereal with help, but won't eat much else at breakfast .took cereal today. Observation on September 11, 2013, at 12:25 p.m., revealed the resident was not in the dining room eating. Continued observation revealed the resident exited their room and ambulated to the foyer area of the nursing unit. Observation revealed the nursing staff redirected the resident back to the dining room to eat lunch. Observation revealed the resident began to eat slowly and alone at a table with no feeding assistance. Interview with the RD by telephone on September 11, 2013, at 2:15 p.m., confirmed the RD had not been asked to review the resident for weight loss from March 2013 to the present and was unaware of the resident's weight loss. Interview with the Director of Nurse's (DON), in the DON's office at 4:00 p.m., on September 11, 2013, confirmed the following: the resident did not have any additional labwork checked since May 2013, the DON had not been able to locate any evaluation by the RD that defined the resident's Ideal Body Weight range, and the Nutritional at Risk committee reviewed the Monthly Weight Record for all the resident's, but had not identified the resident's monthly decline in weight prior to August 23, 2013. Resident #79 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the Departmental Notes dated May 3, 2013, revealed .wt (weight) 135 (pounds) had a recent diet change receives Puree meat with soft veggies . Review of the weight record revealed the resident's weight was 133 pounds on June 3, 2013, and 120 pounds on September 2, 2013, (10 percent weight loss in 3 months) Medical record review of the Dietitian's Recommendations dated May 31, 2013, revealed .recommendation .Nepro 1 can po (by mouth) bid (twice a day) between meals . Medical record review of the physician's progress note dated June 11, 2013, revealed .dietary noncompliance-pt. (patient) eats what .wants (and) refuses what .doesn't want . Medical record review of a physician's orders [REDACTED].D/C (discontinue) shake (with) meals .begin Nepro 1 can BID between meals . Medical record review of the Medication Record dated June 17, 2013, revealed the Nepro 1 can bid was implemented on June 17, 2013. (seventeen days after the dietary recommendation) Medical record review of the Departmental Notes dated July 13, 2013, revealed .Poor diet, Ensure offered and taken well . Medical record review of the Departmental Notes dated August 1, 2013, revealed .wt. 125 (pounds) .continues to receive Puree Meat with soft vegetables diet as ordered .Weight down 4 (pounds) x 90 days due to reduction in doughnuts and sweets family would bring to facility. Family has stopped bringing these items, intake of meals 80 (percent) . Medical record review of the Departmental Notes dated August 23, 2013, revealed .NAR (nutrition at risk) weight trending down will provide shake tid (three times a day) with meals. Weekly weight . Review of the NAR meeting minutes dated August 30, 2013, revealed .Family not providing as many snacks . Observation on September 11, 2013, at 8:50 a.m., revealed the resident sitting on the bed eating breakfast, consisting of oatmeal, eggs, yogurt, milk, and mighty shake with a staff member sitting next to the resident to offer the resident encouragement to eat. Interview with the Registered Dietitian (RD) on September 11, 2013, at 1:20 p.m., by telephone confirmed the RD was not aware of the resident's continued weight loss and would have increased the nepro to three or four times a day. Interview with the Certified Dietary Manager (CDM) on September 11, 2013, at 3:00 p.m., in the conference room, confirmed a delay in starting the RD recommendation for the Nepro 1 can BID. | 2017-02-01 |