Survey reports mix-ups in patient menus

February 14, 1993|By Donna E. Boller | Donna E. Boller,Staff Writer

A heart attack victim in Carroll County General Hospital's critical care unit got four to eight times as much salt in his meals as the doctor ordered.

A 78-year-old burn victim's needs for increased calories and protein were not identified by the hospital's registered dietitian.

Two male patients, one 89 years old and one 50 years old, were placed on restricted diets that contained inadequate amounts of calcium and vitamin D, but no one identified the deficiencies and provided supplements.

A 54-year-old woman who was admitted to the hospital's psychiatric unit was given a 1,500-calorie daily diet, but when her physician changed the order to 1,800 calories, the patient continued to receive 1,500. She lost an estimated 18 pounds in her one-month stay, but, because she had not been weighed on admission, her exact weight loss could not be verified.

These and other errors in Carroll County General's dietary department are reported in a random survey for the federal Health Care Financing Administration that was conducted to check the hospital's eligibility for Medicare reimbursements.

The survey team did not require the hospital to make changes but criticized the mix-ups and declared that the hospital's dietary department is understaffed.

Pamela B. Shafer, a Carroll County General Hospital vice president, said the mistakes did not create any known medical problems for the patients.

But the federal agency placed Carroll County General under direct state supervision and warned that the hospital could lose Medicare eligibility if it does not bring its medical records up to standards.

The survey team considered the food service problems isolated incidents.

Carroll County General did not hire additional dietary workers after the September 1992 survey, but Mrs. Shafer said a request for more personnel is expected to be included in the hospital's budget proposal for the fiscal year that begins July 1.

Mrs. Shafer said that with a maximum of 148 patients -- the hospital's capacity -- receiving three meals a day, the number of meals in which the survey team found problems represents a small percentage.

"Hospitals are so multidisciplinary, it's not that one person screwed up royally but that the system broke down," she said.

The dietary staff includes one full-time inpatient clinical dietitian, one part-time outpatient clinical dietitian and two registered dietetic technicians.

Marcea Cotter, the hospital's food service director, said the part-time dietitian has begun helping with inpatient diets. The two technicians, who formerly supervised the kitchen staff, are now doing initial screening of inpatients to make sure their nutrition needs are met.

The survey team pointed to transcription errors in some of the wrong diets.

Mrs. Cotter said she could not say with certainty that the problem cases pointed out by the survey team resulted from difficulties in reading physicians' handwriting, "but that is quite often a problem."

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