Failure to Ensure Timely and Complete Dialysis Orders and Fluid Restriction Parameters
Penalty
Summary
A resident with end stage renal disease and dependency on dialysis was found to lack timely and complete physician orders for dialysis services. Observation revealed the resident had multiple cups of liquid and a large bottle of juice at the bedside, while the electronic medical record (EMR) did not contain a physician order for dialysis or clear directives regarding fluid restrictions. Additionally, there were no orders restricting staff from obtaining blood pressures on the resident's left arm, which contained an arteriovenous (AV) fistula used for dialysis. Documentation showed that blood pressures were recorded on the left arm on several occasions despite the presence of the AV fistula. Interviews with facility staff, including an LPN and the DON, confirmed the absence of a dialysis order in the medical orders section of the EMR and uncertainty about whether special instructions in the EMR qualified as medical orders. The facility's policy required a physician order for hemodialysis and monitoring of fluid restrictions for dialysis residents, but these requirements were not met for this resident. The lack of clear and accessible orders and directives created the potential for missed treatment, compromised vascular access, and inadequate fluid management.