cms_ID: 38
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 38 | BINGHAM MEMORIAL SKILLED NURSING & REHABILITATION | 135007 | 98 POPLAR STREET | BLACKFOOT | ID | 83221 | 2016-06-17 | 325 | D | 0 | 1 | J25411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff and family interview, it was determined the facility failed to ensure 1 of 19 sampled residents (Resident #5) was provided with care and services to ensure maintenance of adequate nutritional parameters. Resident #5 was not assessed for nutritional requirements to ensure her tube feeding regimen met her nutritional needs, and her tube feeding regimen was not reassessed in light of a significant weight loss, risk for skin breakdown, constipation, and onset of [DIAGNOSES REDACTED]. Findings include: Resident #5 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Resident #5 received all food and fluids via a gastrostomy (G) tube, had a [MEDICAL CONDITION], and received oxygen continuously [MEDICAL CONDITION]. Resident #5's 2/21/16 annual MDS assessment documented she was in a persistent vegetative state. Resident #5 was prescribed insulin and 2 medications daily for constipation. Resident #5 was observed during the survey from 6/12/16 - 6/17/16 to be non-responsive and totally dependent on staff for all cares. When the surveyor introduced herself to Resident #5 on 6/13/16 at 11:30 am, she did not respond in any manner. A Physician order [REDACTED].#5 was prescribed (on 12/10/14): Vital 1.0, 1 can, bolus feeding, twice a day at 4:00 am and 10:00 pm. This provided 20 grams (gm) of protein, 474 ml formula, and 474 calories a day. The amount of water the tube feeding formula provided was not documented. Resident #5 was also prescribed Vital High Protein, 1 can, bolus feeding, twice a day at 10:00 am and 4:00 pm. The Vital High Protein provided 42 gm protein, 474 ml formula, 474 calories. The amount of water the tube feeding formula provided was not documented. Resident #5 was also prescribed [MEDICATION NAME], one packet per day. Review of the nutritional analysis from Hormel Health Labs manufacturer, [MEDICATION NAME] instant whey protein supplement provided 8 gm protein and 30 calories. In regards to fluids, Resident #5 was prescribed (on 6/17/15): 100 cc water flush before and after the tube feed bolus to equal 800 cc/day four times a day at 10:00 am, 4:00 pm, 10:00 pm, and 4:00 am. Additional free water with medications equaled 780 ml per day. Calculations of the above nutrition plan (including water provided in the tube feeding formula per manufacturer's nutrition analysis) were completed. The calculations showed Resident #5 received a total of 978 calories, 70 gm protein, and 1977 ml of water per day. The Dietitian was interviewed on 6/15/16 at 9:30 am, and stated Resident #5 weighed 247 lbs in (MONTH) (YEAR) and the goal was for her to lose weight. Based on 247 lbs, Resident #5 lost 68.5 lbs over the past year and 5 months. Resident #5's most recent weight was 178.5 lbs on 6/2/16, recorded in the Matrix software, and her weight was 185.3 lbs on 3/10/16. Resident #5 lost 6.8 lbs, a 3.6% weight loss, in approximately 90 days, prior to the survey. The Medications Flowsheet for (MONTH) (YEAR), documented Resident #5 had a BG level of 61 on 5/27/16 at 9:00 pm. A nurse's note the next day, on 5/28/16 at 4:14 am, documented Resident #5's tube feeding was given in response to the BG of 61, with an improvement to 145 within an hour after the feeding was administered. There was no documentation demonstrating the physician or dietitian were notified of the low BG level on this date. The Medications Flowsheet for (MONTH) (YEAR), documented Resident #5 had subsequent [DIAGNOSES REDACTED] incidents on 6/2/16 and 6/3/16, with a BG of 69 recorded at 9:00 pm on 6/2/16. According to the Medications Flowsheet, Resident #5's BG level was rechecked and was 120. A nurse's note the next day, on 6/3/16 at 6:30 am, documented Resident #5's tube feeding was given in response to the BG of 69 with prompt improvement to 120 noted after the feeding was administered. The nurse's note further stated Resident #5's BG level was rechecked prior to the 4:00 am tube feeding and was 59, with an improvement to 124 noted after the feeding. Documentation showed the physician and dietitian were notified. Interview with Resident #5's family member (Family Member #3) was conducted on 6/15/16 at 5:30 pm. Family Member #3 stated Resident #5 was dependent on staff for care. She verified Resident #5 was in a persistent vegetative state, all nutrition was provided via a G tube, she was a diabetic and had been experiencing new onset of low blood sugar incidents, and had lost a lot of weight. She stated it had been the goal for Resident #5 to lose weight, but now (as of this week) the goal was for her weight to stabilize. When asked if there was anything else important to note at the conclusion of the interview, she stated she was concerned about the skin breakdown to Resident #5's buttocks. Resident #5's most recent protein level, [MEDICATION NAME], was obtained on 1/1/15. According to the Laboratory Detail report, Resident #5's [MEDICATION NAME] was 3.2, low, with a normal range of 3.4-5, according to the report. Her protein status had not been re-evaluated since 1/1/15, a year and 5 months prior, however, she had sustained a weight loss of 68 lbs since that time. On 6/15/16 at 9:00 am, Resident #5 was observed during a skin assessment to have an approximately 0.5 diameter open area surrounded by scar tissue on her left buttocks. Resident #5 had multiple areas on her buttock of resolved skin breakdown. Resident #5's care plan, with a start date of 5/26/16, identified the nutritional problem of, I have potential for altered nutritional needs secondary to not being able to feed myself and need a feeding tube for all foods and fluids to meet my nutritional needs. The goal was, I will maintain adequate nutritional status through next review and will continue to tolerate my feedings until the next review date. Resident #5's weight loss was not identified on the care plan and the goal did not identify weight loss as currently being a goal. Resident #5's risk of skin breakdown, most recent low protein level, and presence of constipation, were not identified on the nutrition care plan. The care plan included the approach of Vital 1.0 and Vital High Protein bolus feeding administration as noted above. Resident #5 had been on the same tube feeding regimen of Vital and Vital High Protein since 12/10/14, however, she had experienced a weight loss of 68.5 lbs in the past year and 5 months, experienced recent low blood sugar incidents, her protein level (prior to 68.5 lb weight loss) was low, had impaired skin integrity to her buttocks, and had a [DIAGNOSES REDACTED]. A nutritional assessment comparing Resident #5's nutritional needs for calories, protein, and fluid, to what the tube feeding regimen provided, was not found in Resident #5's record. The Observation Report for nutrition, dated 2/23/16, was identified by the Dietitian as being the most recent full nutritional assessment. The report did not identify what Resident #5's nutritional needs were or include a comparison and analysis in regards to what her tube feeding regimen provided. The Observation Report for nutrition, dated 2/23/16, documented 948 calories, 74 gm of protein, 906 ml of free water, and 800 ml of other water were provided daily by the tube feeding regimen. A calculation of the water provided from the tube feeding formula was not made on this assessment or anywhere else in Resident #5's record. The section for total water intake was not filled out and was blank; however, the box was checked indicating total water intake was sufficient. Per the surveyor's calculations, Resident #5 received a total of 1977 ml of water per day (water in the tube feeding formula 397 ml, free water 800 ml per physician's orders [REDACTED].#5's nutritional requirements for calories and protein were not documented. The Dietitian was interviewed on 6/15/16 at 9:30 am, and stated the Matrix nutrition assessment form (Observation Report) did not include a section for nutrition requirements and that was why it was not documented. Per surveyor's request, the Dietitian hand wrote on the Observation Report for nutrition, dated 2/23/16, Resident #5's daily nutritional requirements as: 1000-1200 calories, 70-84 gm protein, and 2100 ml water. Resident #5's tube feeding regimen provided 1977 ml of water which was less than her requirements of 2100 ml per the Dietitian's calculations. Resident #5's tube feeding regimen provided 948 calories which was less than her requirements of 1000-1200 calories per the Dietitian's calculations. Resident #5 was receiving less calories and fluid than her requirements, which had not been identified in the facility's nutrition assessment process. Per the Dietetics in Health Care Communities, Dietetic Practice Group of the Academy of Nutrition and Dietetics, Pocket Resource for Nutrition Assessment 2013 Edition, page 13, The first step in the Nutrition Care Process is the completion of a nutritional assessment and determination of nutrition needs. | 2020-09-01 |