IDPH has cited and fined Heartland of Moline nursing home after a resident there developed aspiration pneumonia due to the failure of the staff to follow orders for a modified diet.
One common condition that nursing home resident suffer from is dysphagia, or a swallowing dysfunction. This condition is commonly associated with the residual effects of a stroke, some neurological condition, generalized weakness, or advanced dementia. Swallow dysfunction can be a deadly condition in that it places the resident at risk for having a nursing home choking accident or developing aspiration pneumonia. Aspiration pneumonia occurs when foreign materials such as food, liquids, or saliva enter the lungs and cause an infection in the lungs.
When a resident is recognized as having a swallow dysfunction, evaluation by a speech therapist is necessary. The speech therapist will then make recommendations regarding the resident’s eating and diet. These recommendations are intended to combat the risks to the health and well-being of the resident, and will often include supervision and assistance with eating as well as modifications to the diet such as a puree or mechanical soft diet and/or thickened liquids. The recommendations of the speech therapist should be incorporated into an order by the physician and into the resident care plan.
The resident at issue suffered from dysphagia and was referred to a speech therapist. The speech therapist confirmed the presence of the swallow dysfunction and determined that a puree diet and moderately thickened liquids was necessary for the safety of the resident. Those recommendations were accepted by the resident’s doctor who issued the appropriate order.
However, shortly after these recommendations were made, the resident was seen with a half finished glass of regular water at lunch. Regular water is considered a thin liquid and giving this to the resident would be a violation of the recommendations of the speech therapist and of the doctor’s orders.
The following day, the resident was running a fever, was disoriented, and had crackling sounds in the lungs. The physician was notified, and he was sent to the hospital where x-rays confirmed the diagnosis of aspiration pneumonia. The resident was suffering from sepsis due to the pneumonia and was placed on comfort care measures only by his family.
This horrific outcome could have been easily prevented. The whole point of having a speech therapy evaluation done is to find out what has to be done to keep the resident safe while eating. When those recommendations (and the corresponding physician orders and care plan) are ignored, this subjects the resident to unnecessary risks of harm. In this case, the recommendation for thickened liquids was not followed by the staff, with a deadly pneumonia being the end result.
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