Inadequate Hydration Due to Mishandling of Fluid Restriction
Penalty
Summary
The facility failed to provide adequate hydration for a resident with severe cognitive impairment, as evidenced by the mishandling of her fluid restriction orders. The resident was on a 1200 milliliters per day fluid restriction, with 900 milliliters to be provided by dietary and 300 milliliters by nursing. Despite these orders, the resident reported that her fluids were frequently taken away by aides, leaving her with dry lips and a feeling of depression. During an interview, the resident expressed that her juices, which she liked to sip on throughout the day, were often discarded by staff, despite requests for them not to do so. An observation confirmed the resident's complaint, as she was seen discussing the issue with the MDS coordinator, who promised to inform the aides not to remove her juice.
Plan Of Correction
F 692 What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: Resident #16 was provided with additional fluid; no other residents were affected by the deficient practice. Resident's BIM score was redone and now 11. Psych services provided for emotional support and Licensed nurses and Certified Nursing Assistants were educated on sufficient fluid intake to maintain proper hydration and health. Additionally, not removing the fluids allowed to the residents. Care plan updated to reflect resident's preference to sip on her drink throughout the day. How you will identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken: Facility audit completed for residents on fluid restrictions to ensure they are receiving adequate hydration as ordered. Director of Nursing/Designee to audit/monitor documentation weekly times four weeks. What measures will be put into place or what systematic changes you will make to ensure that the deficient practice does not recur: Assistant Director of Nursing/designee will re-educate nursing staff on the following: Ensure residents with fluid restrictions have adequate time for consumption. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put in place: Will conduct audits weekly times four weeks. Director of Nursing /designee will report findings at monthly QAA&C monthly times three months or until substantial compliance is achieved.