Failure to Adhere to Physician-Ordered Fluid Restriction
Penalty
Summary
The facility failed to follow a physician-ordered fluid restriction for one resident with diagnoses of congestive heart failure and chronic kidney disease. The resident's care plan and physician's order specified a 1200 cc per 24 hours fluid restriction, with specific allocations for dietary and nursing staff. However, documentation showed that on multiple days, the resident received fluids significantly exceeding the prescribed limit, with totals ranging from 1320 cc to 2800 cc in a 24-hour period. Observations also revealed that the resident had access to a water pitcher and additional fluids at the bedside, contrary to the fluid restriction order. Interviews with staff confirmed that the resident should not have had a water pitcher at the bedside and that a fluid restriction sign specifying the allowed amount should have been posted in the room. On one occasion, the fluid restriction sign was missing, and when present, it did not indicate the specific restriction amount. The facility's policy required adherence to physician orders, removal of water pitchers for residents on fluid restrictions, and clear communication of restrictions to staff and visitors, but these procedures were not consistently followed.