Failure to Monitor Dialysis Access and Enforce Fluid Restriction for Resident on Hemodialysis
Penalty
Summary
A deficiency occurred when the facility failed to provide safe and appropriate dialysis care for a resident with end stage renal disease who was dependent on hemodialysis. The resident had a right upper chest quinton catheter for dialysis access and was cognitively impaired, requiring staff assistance for most activities of daily living. The care plan required monitoring of the dialysis access site for signs of infection, bleeding, pain, clotting, swelling, drainage, and discoloration, with documentation of monitoring every shift. However, review of the Medication Administration Records (MAR) showed no documentation that the resident’s right upper chest quinton catheter was monitored as required by the care plan. Both the registered nurse and the director of nursing confirmed that licensed staff did not implement the care plan intervention and did not monitor the catheter site. Additionally, the facility failed to implement a physician’s order for fluid restriction for the same resident. The physician’s order and care plan specified that no water pitcher should be placed at the resident’s bedside to help manage fluid intake. Despite this, observations revealed a full pitcher of water, a glass of milk, and juice at the resident’s bedside, and the infection preventionist confirmed that staff failed to follow the fluid restriction order. The facility’s policy also required the removal of water pitchers for residents on fluid restrictions, but this was not followed in practice. The facility’s policies and procedures for care of residents receiving renal dialysis and for fluid-restricted diets both required assessment and monitoring of central line sites and adherence to physician-ordered fluid restrictions. The failure to monitor the dialysis access site and to enforce fluid restrictions were confirmed by staff interviews and record reviews, indicating that the facility did not follow its own policies or the resident’s care plan and physician orders.