Failure to Ensure Proper Hydration for Resident with AKI and Poor Oral Intake
Penalty
Summary
A deficiency was identified when the facility failed to ensure proper hydration for a resident with a history of acute kidney injury (AKI), dehydration, significant weight loss, variable oral intake, and diuretic use. The resident had a physician's order for intravenous (IV) sodium chloride solution to be administered three times a week to address hydration needs. Observations and interviews revealed that the resident was not receiving IV fluids as ordered, with staff noting that the IV was not started as scheduled and that sometimes night nurses administered fluids earlier than ordered. On one occasion, the resident was not hooked up to IV fluids in the morning, and the unit manager confirmed that the scheduled IV was not administered the previous night. The resident was also observed to have poor oral intake, often refusing meals and not consuming adequate fluids, which was acknowledged by staff as a reason for providing supplements and IV fluids. Despite these interventions, the resident was not observed to be receiving IV fluids during multiple observations, and documentation inconsistencies were noted regarding the administration of the IV fluids. The facility's policies required medications and hydration to be provided as ordered, but these were not consistently followed, resulting in a failure to maintain the resident's hydration status as prescribed.