Failure to Monitor and Manage Resident's Fluid Intake
Penalty
Summary
The facility failed to adequately monitor and manage the hydration status of a resident with specific fluid restrictions due to chronic health conditions. The resident, who has chronic diastolic congestive heart failure, atrial fibrillation, and chronic respiratory failure with hypoxia, had a physician-ordered fluid restriction of 1500 cc per day. However, the facility's policy did not specify how to manage fluid intake for residents with such restrictions, and there was no documentation on how the resident's fluid intake was distributed throughout the day or monitored daily. On two occasions, the resident's fluid intake exceeded the prescribed limit, with 3370 cc consumed on one day and 1560 cc on another. There was no documentation of fluid intake during medication administration, nor was there evidence that the physician was informed of the excess fluid intake. During an interview, the DON confirmed the lack of documentation and monitoring, acknowledging that the resident's fluid intake should have been tracked and communicated to the physician when limits were exceeded.
Plan Of Correction
1. At time of discovery the fluid restriction batch orders were updated for R50 to be reflective of her specific restrictions and the distribution of those fluids from dietary and nursing. There were no negative outcomes identified. 2. Education was provided to the nursing and dietary departments by the DON/designee on proper reading of the fluid restriction orders, dietary and nursing's role in maintaining these orders relative to the patient's plan of care. An audit was completed of Residents on fluid restrictions and had their orders changed to be reflective of her specific restrictions and the distribution of those fluids from dietary and nursing. 3. An audit will be conducted for patients on fluid restrictions k x 2 weeks then monthly x 2 months to ensure that fluid restrictions are being properly administered per order. 4. Results of the audit will be taken to QAPI for review of findings and further interventions if indicated.