| 9162 |
WAR MEMORIAL HOSP, D/P |
5.1e+151 |
1 HEALTHY WAY |
BERKELEY SPRINGS |
WV |
25411 |
2013-02-13 |
367 |
D |
1 |
0 |
1G6H11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and physician interview, the facility failed to follow physician's orders for a prescribed diet, or alternatively, to consult the physician regarding a need for a change in the resident's diet order for one (1) of five (5) sampled residents. Resident identifier: #1. Facility census: 14. Findings include: a) Resident #1 Observation of the morning meal, on 02/13/13 at 8:30 a.m., found Resident #1 being assisted with his meal which included french toast. He showed no visible signs at that time of choking, or difficulty swallowing. Observation of the noon meal, on 02/13/13 at 12:15 p.m., found a nursing assistant sitting by his side in the dining/activity room, assisting him with his meal. He was served a chicken salad sandwich that had been cut in half, as well as soup and some pureed food and Ensure. During an interview with a licensed nurse, Employee #14, on 02/13/13 at 12:30 p.m., she said Resident #1 was on a regular diet when he first arrived from an assisted living facility, but he would not eat well. He would pocket food in his cheek. He had no dentures and no natural teeth, and he could not chew all foods on a regular diet. He received a regular diet at breakfast with soft foods such as scrambled eggs and french toast or pancakes with syrup. She said he was served a soft sandwich at lunch and dinner daily. Sometimes he refused the sandwich, and at other times he ate nothing but the sandwich. He also received soft textured foods such as ice cream, pie without the hardened crust, cake, soft vegetables, soup, soft fruit such as bananas. She said the texture of the food served was in relation to his being edentulous. She said his food intake declined while on a regular diet, but increased when the texture was changed to pureed. She said he did not choke on foods to her knowledge. Review of a social service care plan note, dated 10/12/12, revealed the Medical Power of Attorney (MPOA) had concerns with pureed food, and the MPOA asked that he have a sandwich at lunch and dinner time. The registered dietitian agreed to try this, and send it along with his pureed food. The Minimum Data Set (MDS) assessment, with an assessment reference date (ARD) of 12/31/12, was reviewed. It revealed his Brief Mental Assessment (BIM) score was only three (3) which signified severe cognitive loss. He was coded as having a swallowing/nutritional status problem with loss of liquids/solids from his mouth, coughing or choking. He was 74 inches tall, and weighed 119 pounds. A dietary progress note, dated 01/03/13, revealed the resident had a regular diet for breakfast and NDD1 (National Dysphagia Diet - a pureed diet) for lunch and dinner. In this note, the dietitian said the resident continued to have loss of liquid from the mouth, coughing and choking at meal times, and he was on a mechanically altered diet. Review of an Informed Refusal form, dated 01/25/13, revealed physical therapy, occupational therapy, and speech/language pathology had made a recommendation for a pureed diet for all meals. This was also recommended by the Interdisciplinary Team (IDT), but was refused by the MPOA. The purpose and benefit of those care or treatment recommendations was noted, as well as the risks of refusing them, and of possible alternatives. The current care plan was reviewed. It revealed the resident received a regular diet for breakfast and a NDD2 (National Dysphagia Diet - a mechanically altered diet) for lunch and dinner, and he coughed and choked at meals at times. Review of the current physician's orders revealed an order for [REDACTED]. During an interview with the MDS coordinator/registered nurse, Employee #18, and consultant administrator, Employee #22, on 02/13/13 at 4:00 p.m., they agreed there was not a physician's order for the sandwiches for lunch and dinner which the resident was receiving daily. During a telephone interview with the physician, on 02/13/12 at 4:30 p.m., he said he recalled the MPOA asking him if it would hurt the resident to have a sandwich once in awhile, to which he told her that it would not hurt him. He said he did not recall if nursing staff had requested sandwiches for the lunch and dinner meals, but said they probably did, and he would write an order to that effect. He said he did not recall anyone asking for regular diets for all meals. |
2016-02-01 |