Failure to Implement Fluid Restriction for Resident
Penalty
Summary
The facility failed to ensure that Resident #163, who had diagnoses including Alzheimer Disease, End Stage Renal Disease, and a history of Tachycardia, maintained acceptable parameters of nutrition and hydration status. The resident was on a physician-ordered fluid restriction of 960 milliliters per day due to dialysis needs, but there was no documented evidence of the implementation of this restriction. The resident's meal ticket did not reflect the fluid restriction, and there was no record of daily fluid intake in the electronic medical record. Staff members, including a Registered Dietician, Kitchen Supervisor, Certified Nurse Aide, and Licensed Practical Nurse, were unaware of the fluid restriction or did not ensure it was documented and communicated properly. The facility's policy on managing fluid restrictions was not followed, as evidenced by the lack of intake and output documentation and the absence of fluid restriction information on the resident's meal ticket. Interviews with staff revealed a lack of awareness and communication regarding the resident's fluid restriction, with the Director of Nursing acknowledging that the meal ticket should have documented the restriction and that intake and output should have been recorded separately. The Food Service Director/Dietician also noted that the dietician was responsible for ensuring the fluid restriction was on the meal ticket and that meal rounds should be conducted to ensure compliance, but these actions were not regularly performed.
Plan Of Correction
Plan of Correction: Approved March 18, 2025 1. The Registered Dietitian responsible for the resident's care re-created a new meal ticket with the physician ordered fluid restriction transcribed onto the ticket. The Director of Food and Nutrition Services counseled the dietitian responsible for transcribing the fluid restriction order onto the meal ticket. All residents care plans were reviewed and updated. 2. The Food Service Management team and dietitians completed a facility-wide audit to identify all residents with a fluid restriction order. All meal tickets were then checked against the audit to ensure accurate entry of prescribed fluid restriction. 3. The Fluid Restriction Policy was reviewed to ensure compliance with F692. All nursing, dietary, and food service employees received in-service training on the Fluid Restriction Policy. a. The Registered Dietician (RD) and Director of Food and Nutrition corrected meal tickets to reflect ordered fluid restrictions. b. All resident care plans and CNA task lists were reviewed and updated to ensure compliance with fluid restriction requirements. 4. The RD will generate and review daily fluid restriction reports 3 times a week to verify that: a. RD acknowledges Fluid Restrictions order in progress Note Section of the EMR. b. RD enters Fluid Restriction Order in Nutrition Care Plan. c. Fluid Restriction appears on the TAR. d. Fluid restriction allowances entered on Meal Ticket. The Registered Dietician/Director of Food and Nutrition Services will report findings of the weekly audits to the QAPI committee monthly x three months for action as appropriate. The Director of Food and Nutrition Services is responsible for the corrective action.