cms_GU: 79
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 79 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 325 | G | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to maintain acceptable parameters of nutrition for weight for 2 of 10 sampled residents ( resident 2 and 6); when 1.) Resident 6 lost 18.5 % of her body weight due to a leaking gastrostomy tube ([DEVICE]) and 2.) Resident 2 did not receive follow up care for weight maintenance. Findings: 1. Resident 6 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The resident had a gastrostomy tube ([DEVICE]) for feeding and a Urinary catheter for elimination. The resident required total assistance for activities of daily living (ADLs). The resident's family member was with the resident most of the time. Observations of the resident on 1/24/2012 during personal care revealed the resident was cachectic (ill health and very thin). During an interview on 1/24/2011 at 10 AM, the resident's family member stated the resident had a feeding tube that leaked for a long time before the facility replaced it. The family member stated the resident lost a lot of weight. During an interview and record on 1/24/2011 at 10:45 AM, the day shift charge nurse stated the [DEVICE] had been leaking almost from admission to Christmas. She stated she was not sure why it took so long for the tube to be changed. Review of Resident 6's record from the Monthly Weight Log read as follows: 10/22/2011 - 103 pounds (lbs) 11/14/2011 - 89.6 lbs 12/10/2011 - 85 lbs ([DEVICE] replaced 12/14/2011) 01/10/2012 - 87.9 lbs The resident lost 18 lbs in approximately 2 months. A summary of the review of the staff and physician notes revealed the following time line: 10/22/2011 - Admission; 10/28/2011 - minimal amount of drainage around the feeding tube; 10/29/2011- greenish discharge from the feeding tube. 11/15/2011 - MD noted added suture at the [DEVICE] site to help reduce leakage. 11/16/2011 - MD noted to request surgeon to revise or change the [DEVICE]. 11/28/2011- feeding tube leaking; 11/30/2011- MD noted the [DEVICE] needed to be changed. 12/3/2011 - feeding tube still leaking, 12/9/2011 - feeding tube still leaking. 12/14/2011- Surgeon replaced [DEVICE] with same size tube, 24 french. 12/27/201 - MD noted [DEVICE] still leaking. Resident to have tube replaced again the next day (12/28) with a 28 french [DEVICE]. 1/13/2012 - MD noted [DEVICE] leak is fixed. During this time frame the MD began the resident on [MEDICATION NAME] one half can every 6 hours then increased to one can every 6 hours. Nurses notes between 10/22 and 11/6/2011 revealed the resident did not tolerate one can, so the feeding was reduced to [MEDICATION NAME] one half can every 6 hours on 11/6/2011 - 31 days after the [DEVICE] leak began. A physician's orders [REDACTED]. On 12/19/2011 the dietician recommended pleasure feeding 1/2 teaspoon puree food and 1/2 teaspoon water at a time. There was no documentation whether or not the resident received this oral feeding or how/if the resident tolerated it. On 12/31/2011 the dietitian recommended and the physician changed the feeding to Nepro 1/2 can every 4 hours. On 1/7/2012 - the physician changed the feeding to Fibersource 1/2 can every 4 hours. Review of the registered dietician (RD) notes dated 1/18/2012 revealed the residents lab results for Serum [MEDICATION NAME] was low at 2.0 grams/deciliter (gms/dcl)- Normal range was 3.4 - 5.0 gms/dcl. Decreased [MEDICATION NAME] may occur when your body does not get or absorb enough nutrients and reduces the body's ability to heal. During an interview on 1/25/2011 at 2 P.M., the RD stated the resident developed diarrhea from the Nepro, therefore the feeding was changed to Fibersource. She stated the weight loss was due to the leaking [DEVICE]. She said the resident was receiving maybe 60% of what was fed to her. When asked if any other means of nutrition was discussed or considered, she stated no. When asked if she was involved in the interdisciplinary care conferences, she stated no, the dietary manager attended and let her know if there were problems. Review of the Care Conference notes dated 12/5&7/2011 indicated the current type and amount of feeding, and a note that the [DEVICE] was leaking. There was no other Care Conference noted provided and no other documentation on what the facility would do to enhance the resident's nutrition to prevent weight loss and improve wound healing during the 69 days that the [DEVICE] was leaking. 2. Resident 2 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Review of the Mini Nutritional Assessment dated 1/07/12, revealed that Resident 2 was nutritionally at high risk and with increased nutrient needs related to severe malnutrition (as evidenced by) severe protein depletion with [MEDICATION NAME], and cachexia . The assessment also noted that weighed 96 lbs and had a height of 5 feet and 5.75 inches. Recommendations made by the dietitian dated 1/07/12 included providing Resident 2 with enteral feedings of [MEDICATION NAME] 1 can every 6 hours for 24 hours increasing to 1 can every 4 hours, and 150 ccs water for flush. This, according to the recommendation would provide the resident with 1500 kcal and 61 gms of protein per day. The recommendation also included monitoring of tube feeding residuals, monthly weights, weekly laboratory tests, and hydration status. During an interview on 1/25/12, a nutritional support staff stated that because of Resident 2's [MEDICAL CONDITIONS] and consideration for a carbohydrate controlled formula, that [MEDICATION NAME] was an appropriate substitute for another solution he was to receive but was unavailable. Review of the medical record however revealed the lack of monitoring of Resident 2 to ensure that identified nutritional risks were being addressed or that interventions were effective. While the resident, for example, was described in a dietary note dated 1/16/12 as being underweight (weight noted on admission on 1/07/12 was 96 lbs), no other weight measurements were obtained until 1/25/12 when a weight of 95.2 was recorded. In addition, there was no documentation if the current enteral feeding regimen, calculated to provide 1500 kcal per day, allowed for weight gain or maintenance of current weight. While the enteral feeding was to provide 61 gms of protein, no measurements of protein stores ([MEDICATION NAME] level) were available following Resident 2's admission to the facility. Review of laboratory results dated [DATE] when Resident 2 was in the hospital revealed an [MEDICATION NAME] level of 2.2 gms/dl (normal limit 3.4 - 5 gms/dl). Further review of the medical record revealed that while a care plan was written for special needs--providing nutritional support, the plan however was developed relative to the risk for aspiration. The care plan, for example, did not identify nutritional goals that needed to be met or indicators that needed to be monitored to help ensure that Resident 2 met established nutritional benchmarks such as weight and/or [MEDICATION NAME] levels. Further review of the care plan revealed the lack of identification of a desired or target weight as a baseline from which the effectiveness of nutritional interventions can be measured. | 2017-01-01 |