Pruitthealth in Dillon, South Carolina has been cited after state investigators found that the facility greatly neglected a resident by failing to do the following:
- Develop a complete care plan within 7 days of comprehensive assessment;
- Have a team of health professionals prepare, review, and revise the care plan;
- Provide enough food and fluids to maintain a resident’s health;
- Obtain a doctor’s order to admit a resident and ensure the resident is under a doctor’s care.
The resident was admitted to the facility weighing 96.4 pounds. Within a six month period, the resident had lost 15.2 pounds and weighed 81.2 pounds. The resident’s care plan did not address her weight loss until she had already lost 8.4 pounds when the Registered Dietitian recommended a Nutritional Treat.
According to the patient’s care plan, a goal was for the resident to “eat to satiety and exhibit no further unexpected significant weight loss (or gain) in 3 months.” To support this goal, the Registered Dietitian was to “evaluate the adequacy of current diet per the protocol and make recommendations accordingly as needed/indicated,” and “encourage nutritional and fluid intake and provide supplements as ordered and indicated.”
Other interventions outlined in the care plan included:
- Offering fluids;
- Encouraging resident to drink all fluids provided;
- Monitoring the resident’s weight;
- Reporting any unexpected or significant changes in weight or nutritional concerns;
- Monitoring the resident for any meal refusals or other behavioral issues that could affect the resident’s nutritional status.
The care plan did not, however, layout “measurable concrete interventions…to reduce weight loss or to prevent further weight loss.” Furthermore, the Care Plan Conference Sheet showed that Dietary Staff did not have any input for this resident’s care plan.
According to the resident’s Nutritional Progress Notes, the resident was experiencing severe weight loss and was only eating about 25-50% of most meals. She already received Ensure four times per day. A nutritional treat was recommended twice daily with meals, but no other interventions were recommended by the Registered Dietitian.
The surveyor tried to contact the Registered Dietitian to inquire about this mishandled situation but was unable to reach them.
While the facility did eventually implement a nutritional intervention to help combat the resident’s excessive weight loss, it was not done soon enough. The resident had been losing weight for months before this intervention was enacted.
Though the facility did create a care plan for the resident, it did not include “measurable, concrete interventions to reduce weight loss,” and therefore was not a fully complete plan. Furthermore, a Dietary Staff did not contribute to the resident’s care plan, nor was the plan closely reviewed or revised.
The nutritional treat intervention was not implemented until the resident had already lost a considerable amount of weight over the course of a six month period. The resident’s weight should have been closely monitored, and their physician should have been notified of any significant changes in weight. Though the resident was only consuming 25-50% of her meals, it was never reported even though this could affect the resident’s nutritional status.
When the physician was made aware of the resident’s weight loss, they told the surveyor they “did not think the family wanted a feeding tube or hospice.” After the surveyor mentioned the Ensure in the resident’s care plan, the physician said they “would discuss a feeding tube with the family.” However, if this investigation was never conducted, it’s likely that a feeding tube would never be discussed and the patient would continue to lose weight in an unhealthy way.
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