An Iowa nursing home cook changed the menus for some of the residents without authorization, which led to the death of a resident by choking. The cook was responsible for preparing meals for the residents of the facility, using the individualized menus created by his supervisor, the facility’s culinary director. The culinary director created the menus based on physician orders, as some of the residents were on restricted diets and could only have soft or pureed food.
The culinary director discovered that the cook had changed some of the residents’ menus, so she changed them back to comply with the physician orders. She reminded the cook that she was the only person authorized to specify how food items were to be prepared and served to the residents. She also told him that it could be fatal to give residents food that posed a choking hazard.
Several months later, two new residents were admitted to the facility. The cook contacted the culinary director and asked if she wanted him to devise menus for the new residents. She told him that she would do it. The cook decided to create the menus himself, and he entered them into the system. He incorrectly indicated that one of the residents could have a regular, unrestricted diet, even though the resident’s medical orders stated that the resident could only have soft, bite-sized pieces of food.
The resident was subsequently given pulled meat instead of ground meat. He choked on the meat, was taken to the hospital, and died. The cook was fired several days later.
Compliance Perspective
Issue
F805 says that facilities are to provide, and residents are to receive, food prepared in a form designed to meet individual needs according to their assessment and care plan. F808 says that residents must receive and consume foods in the appropriate form and/or the appropriate nutritive content as prescribed by a physician, and/or assessed by the interdisciplinary team to support the resident’s treatment, plan of care, in accordance with his or her goals and preferences. The attending physician may delegate to a registered or licensed dietitian the task of prescribing a resident’s diet, including a therapeutic diet, to the extent allowed by State law. If a resident’s attending physician delegates this task, he or she must supervise the dietitian and remains responsible for the resident’s care even if the task is delegated. The physician can modify a diet order with a subsequent order, if necessary.
Discussion Points
- Review policies and procedures on food and nutrition services, individualized restricted diets per physician or designee orders, and resident care plans. Also review policies and procedures related to staff responsibilities and scope of practice.
- Educate staff regarding the importance of following physician orders, and not performing unauthorized tasks. Provide education on the necessity of comparing written meal cards to the plated food and beverages for accuracy and resident safety at every meal.
- Periodically perform audits for accuracy comparing doctors’ orders in the medical record to diet sheets followed by dining services staff. At each meal, ensure that staff audit to ensure residents’ foods and beverages are the correct consistency before serving, and that physician orders and resident care plans are being followed for both meal consistency and provision of assistive devices.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
