Failure to Adhere to Fluid Restriction Orders for Resident with SIADH
Penalty
Summary
A deficiency was identified when a resident with a diagnosis of Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH), which requires careful fluid management, was not provided care in accordance with physician orders. The resident had a physician's order for a fluid restriction of 1,500 ml per day, and the care plan specified that the kitchen would provide 1,200 ml, leaving 300 ml for other fluids. Despite these orders, the resident's fluid intake records showed that on multiple days within the review period, the resident consumed more than the prescribed 1,500 ml limit, with intake ranging from 1,510 ml to 2,220 ml on several days. Staff interviews revealed that the resident was aware of being on a fluid restriction but could not specify the allowed amount. The Director of Nursing (DON) acknowledged that the resident's fluid intake was not adequately controlled or monitored, and that closer monitoring should have been implemented to ensure compliance with the fluid restriction order. This failure to follow professional standards of care and physician orders resulted in the resident receiving more fluids than prescribed.