Last year my facility received a F242 tag for not overtly offering a patient with CHF, Gout, edema etc. bacon during the admission interview. I kid you not. It is exactly what happened. The patient called the state instead of asking for the RD to meet with them again. State came in and determined that she was not offered bacon. This is correct. I also did not offer her a flame thrower or cigarettes.

Fast forward to this week where a family member, with a nurse in tow, went to the kitchen to demand ice cream, gravy, and fluids for her son who is on a strict Pureed "No PO fluids" order by SLP. He is hydrated enterally. The DON and ADON are scared for a tag and think I am wrong to state there is an acute safety issue here and not appropriate for circumnavigation. Out facility does not recognize waivers for these cases.

Thoughts?

Last year my facility received a F242 tag for not overtly offering a patient with CHF, Gout, edema etc. bacon during the admission interview. I kid you not. It is exactly what happened. The patient called the state instead of asking for the RD to meet with them again. State came in and determined that she was not offered bacon. This is correct. I also did not offer her a flame thrower or cigarettes. Fast forward to this week where a family member, with a nurse in tow, went to the kitchen to demand ice cream, gravy, and fluids for her son who is on a strict Pureed "No PO fluids" order by SLP. He is hydrated enterally. The DON and ADON are scared for a tag and think I am wrong to state there is an acute safety issue here and not appropriate for circumnavigation. Out facility does not recognize waivers for these cases. Thoughts?

Check with your facility administrator on the correct policy for documentation of residents' refusal to follow therapeutic recommendations. Residents do have the right to refuse to follow recommendations, but must be educated on the risk of refusal (i.e. the risk of aspiration in drinking liquids against SLP recommendation). I would do the education with another witness and both chart on the education, just in case something "comes up" (wink). CYA.

Check with your facility administrator on the correct policy for documentation of residents' refusal to follow therapeutic recommendations. Residents do have the right to refuse to follow recommendations, but must be educated on the risk of refusal (i.e. the risk of aspiration in drinking liquids against SLP recommendation). I would do the education with another witness and both chart on the education, just in case something "comes up" (wink). CYA.
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