Failure to Ensure Adequate Hydration and Nutrition
Penalty
Summary
The facility failed to ensure adequate hydration and nutrition for one of the sampled residents. The resident, who was noted to have good mental cognition, was identified as lactose intolerant, and the medical doctor was informed by the registered dietitian to change the resident's supplement to Ensure Clear. However, there was a lack of documentation and monitoring of the resident's fluid intake by the nursing staff, specifically by Staff D, LPN, who did not record progress notes regarding the resident's fluid intake. Additionally, the multidisciplinary team did not conduct a nutritional evaluation related to the resident's medications. The nursing care plan for the resident did not include a focus on fluid and nutrition maintenance or any interventions to maintain the resident's fluid and nutrition status. Interviews with staff revealed a lack of recollection regarding monitoring the resident's fluid status, and the resident's physician indicated that he did not see a need for fluid orders until a later date, despite the resident's condition. This lack of coordinated care and documentation contributed to the deficiency in maintaining the resident's nutritional and hydration status.
Plan Of Correction
How the corrective action will be accomplished for any resident affected by deficient practice: Resident #1 no longer resides at the facility. The facility completed a review of the resident #1 clinical record for any opportunity of improvement in facility clinical services. RD# 1 no longer works at the facility. Staff G. RD#2 was educated on the Facility's policy, titled Resident Hydration and Prevention of and to monitor and assess residents with nutritional risk including risk for evaluation related to receiving medications such as medications and. Facility has hired a second RD that was educated on the Facility's policy, titled Resident Hydration and Prevention of to ensure monitor and assess residents with nutritional risk including risk for evaluation related to receiving medications such as medications and. Staff A, LPN and Staff D, LPN were educated on monitoring residents' fluid intake as per MD order and documenting in medical order, medical records and monitoring CNA task were reviewed to ensure include fluid intake. Resident #1 physician is no longer employed at the facility. How we identified other residents/areas that could potentially be affected and what corrective action will be taken: All residents on medications have potential to be affected by this practice. An audit of residents on medication was conducted to ensure their hydration status and electrolyte balance are monitored. All residents on were audited to ensure they have recent laboratory values that show a balance electrolyte panel. Care plans were updated accordingly, and interventions were implemented where necessary to ensure adequate hydration and nutrition. Any findings were addressed immediately. No additional adverse outcomes were identified audit of all current. Measures put in place or systemic changes made to ensure that the deficient practice will not recur: The facility's policy, titled Resident Hydration and Prevention of was reviewed by Director of Nursing and Registered Dietitian and no revision was required. Facility Registered Dietitians, Licensed nursing staff, and IDT team were educated on the above policies and education include: Fluid Intake monitoring protocols and reinforced among staff. Recognition of nutritional/hydration risks, especially related to medications such as. Residents at risk of nutritional/hydration status will be evaluated on a routine basis during the facility risk weekly meeting. Unit Managers/Supervisors will monitor clinical alerts including poor intake during the morning meeting and the end of each shift and any abnormality will be reported to MD and Registered Dietitian for immediate interventions. Registered Dietitian will evaluate residents with nutritional/hydration risks on a monthly basis and as needed as per clinical alerts to ensure their nutritional/hydration needs have been addressed. How the corrective actions will be monitored and what quality assurance will be put in place title of person responsible for monitoring: The Director of Nursing or designee will audit 10 residents with nutritional/hydration risks weekly x 4 then monthly x3 to evaluate that they have an individualized plan of care in place as well as to ensure they maintain a proper hydration status and electrolyte balance. The results of all audits will be reported to QAPI committee for review and feedback on a monthly basis for the duration of audit until compliance achieved. Responsible party: DON