Failure to Enforce Physician-Ordered Fluid Restriction
Penalty
Summary
The facility failed to follow physician-ordered fluid restrictions for a resident with multiple medical diagnoses, including renal insufficiency, coronary artery disease, and a history of urinary retention requiring a Foley catheter. The resident had a documented fluid restriction order limiting intake to 2 liters per 24 hours, with specific allocations for dietary and nursing staff. The care plan reflected these restrictions and included interventions to monitor and educate the resident regarding fluid intake. Despite these orders, observations revealed that the resident consistently had access to large cups of water at the bedside, which were refreshed regularly, and the resident reported being able to drink as much water as desired. Interviews with staff indicated a lack of awareness regarding the resident's fluid restriction, with a CNA stating they were not informed of the restriction and routinely provided additional fluids, especially in hot weather. The Assistant Director of Nursing confirmed the presence of the fluid restriction order and the rationale for its implementation following a recent hospitalization for urinary retention and altered mental status. The failure to communicate and enforce the fluid restriction order resulted in the resident having unrestricted access to fluids, contrary to physician orders and the resident's care plan.