Failure to Monitor Kidney Function Following Dietician Recommendation
Penalty
Summary
The facility failed to provide the recommended laboratory monitoring for a resident with chronic kidney disease who was receiving high protein supplementation. The resident had diagnoses including a left femur fracture, mild cognitive impairment, and stage 3b chronic kidney disease, and was noted to have developed stage 2 and 3 pressure ulcers after admission. Laboratory results from an earlier date showed significantly elevated blood urea nitrogen and creatinine levels. The registered dietician assessed the resident and recommended monitoring kidney function due to the increased protein intake, which exceeded 107 grams per day with supplementation. Despite the dietician's recommendation, there was no evidence that the medical provider (MD or NP) was informed of the increased protein supplementation or the need for closer kidney function monitoring. The dietician was also unaware of the available laboratory results in the medical record, and the nurse practitioner would not have ordered new labs until six months after the previous results. Facility policy required communication of dietician recommendations to other departments for follow-up, but this did not occur, resulting in a lack of appropriate monitoring for the resident's kidney function.