Failure to Implement and Monitor Physician Orders for Fluid Restriction, Daily Weights, and Compression Management
Penalty
Summary
The facility failed to implement and monitor physician orders for three residents, resulting in deficiencies in the provision of care. For one resident with diagnoses including edema, chronic kidney disease, and congestive heart failure (CHF), a physician's order for a two-liter fluid restriction was not documented or monitored in the electronic medical record (EMR). Staff interviews revealed that the order was entered incorrectly and overlooked, and the required documentation and departmental notifications were not completed as per facility policy. Another resident with CHF and an indwelling catheter had a physician's order for daily weights to monitor for fluid retention, with instructions to notify the physician if certain weight gains occurred. Review of the medication and treatment administration records, as well as vital signs documentation, showed that daily weights were not consistently obtained or recorded on multiple dates, and there was no evidence that the physician was notified when weights were missed or refused. Staff interviews indicated that all staff were responsible for obtaining weights and that physician notification should occur if refusals were frequent, but this was not documented in the clinical record. A third resident with lymphedema, diabetes, and a history of venous ulcers had physician orders for specific pressure-relieving devices and compression management, including the use of tubi grips and avoidance of ace wraps as directed by a vascular physician. Observation found that the resident's lower extremities were wrapped with ace wraps instead of the ordered tubi grips, contrary to the physician's instructions. Staff interviews confirmed that ace wraps were applied in error and that all physician orders should be followed. These failures to implement and monitor physician orders placed the residents at risk of delayed treatment and untreated illness.