Failure to Follow Physician-Ordered Fluid Restriction
Penalty
Summary
A deficiency occurred when the facility failed to follow a physician's order for a fluid restriction for one resident with diagnoses including heart failure, end stage renal disease, and dependence on renal dialysis. The resident was prescribed a 1,200 ml fluid restriction per 24 hours, with specific allocations for nursing and dietary staff. Despite this, record review showed that the resident received fluids in excess of the prescribed limit on multiple days, with documented intakes ranging from 1,357 ml to 2,537 ml. Observations also revealed that the resident had access to additional fluids at the bedside, including a cup with liquid and multiple bottles of water, which were not accounted for in the fluid restriction plan. Interviews with facility staff indicated a lack of communication and monitoring regarding the resident's fluid intake. The dietitian was unaware that the resident was receiving fluids outside of the restriction and expected nursing to monitor and address any deviations. The DON confirmed that the expectation was for the fluid restriction to be followed as ordered. Facility policy required that fluid restrictions be adhered to according to physician orders, with proper documentation and communication if the resident refused the restriction, but there was no evidence that these procedures were followed in this case.