Blue Ridge of Sumter was cited after the facility “failed to notify the physician of [the] presence of multiple daily episodes of behaviors, specifically chewing on clothing and/or linen to the point of destruction.” These behaviors indicated the presence of pica, an eating disorder involving the consumption of things not typically thought of as food; it often occurs in people with other mental health disorders. The lack of follow-up put the resident at risk for consuming harmful substances that could result in severe stomach problems.
The resident in this citation was admitted to the facility with “unspecified intellectual disabilities… and specified developmental disorder of motor function.” He was known to be nonverbal and “unable to participate independently with individual or group activities related to cognitive deficits and physical deficits.” The resident also exhibited recurrent, destructive behaviors; he would chew on his clothing or linens to the point where the cloth would shred. This resulted in the release of threads that could be breathed in and/or swallowed by the resident, resulting in gastrointestinal complications.
An observation of the resident was conducted in regards to his behaviors. The investigator observed the resident lying in bed chewing on a damaged hospital gown. This behavior observation was immediately verified by a Licensed Practical Nurse (LPN). The investigator reviewed the resident’s medical record, looking for notes about the resident’s chewing habits. Only a social worker’s notes revealed the resident’s ongoing chewing of garments and linens. Upon interviewing a few Certified Nursing Assistants, the investigator discovered the resident had to have his gown changed once per shifted because of his chewing behavior.
The investigator then interviewed a nursing home physician. The physician stated she was not aware of the resident’s chewing issues, referred to as “pica” by the staff. Pica is an eating disorder that involves eating items that aren’t typically considered food such as hair, dirt, material, etc. The physician stated the resident must be hungry, so she would try giving the resident double portions. When the investigator asked whether or not the physician considered the chewing a behavioral issue, she stated “when someone tries to put something in their mouth… it usually means that they are hungry.” The investigator asked if the resident had recently been seen by a psychiatric specialist. She said she didn’t remember the resident being seen by anyone else; he had been at the facility for a long time.
At the conclusion of the physician’s interview, the resident was seen sitting in direct view of the physician, actively chewing on a blanket. The physician didn’t identify the behavior as pica but agreed the resident was chewing on the blanket. A new order was initiated for the resident to get double portions for lunch and supper. The facility also planned to refer the resident to appropriate professionals who could evaluate the resident’s pica-related behavior.
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