Failure to Adhere to Fluid Restrictions and Provide Meals for Dialysis Residents
Penalty
Summary
The facility failed to provide dialysis care and services in accordance with physician orders and resident needs for two residents requiring dialysis. For one resident with end-stage renal disease and a physician-ordered daily fluid restriction of 1200 ml, the order did not specify how much fluid should be provided by dietary services with meals and how much should be given by nursing staff throughout the day. As a result, the resident's fluid intake records showed multiple days where intake exceeded the prescribed limit. Staff interviews revealed inconsistent knowledge and communication regarding the breakdown of fluid allocation between departments, and the Director of Nursing was unaware that nursing staff did not have clear instructions on fluid distribution. Additionally, the same resident's care plan indicated a fluid restriction, and laboratory results showed increased fluid weight gain, suggesting non-adherence to the restriction. Observations confirmed the resident had access to fluids beyond the prescribed amount, and staff reported that the resident would often request and receive additional fluids. The Registered Dietitian was aware of the dietary fluid allocation but did not know if nursing staff were informed of their portion, further highlighting the lack of coordination. For another resident dependent on dialysis, the facility failed to provide a bagged meal or snack on dialysis days. The resident reported not receiving food when going to dialysis and expressed a desire for a meal or snack. Staff interviews and review of the dialysis resident list revealed that this resident was not included on the list used to prepare and distribute food bags, resulting in the omission. The Director of Nursing confirmed that the resident should have received a snack, and the Administrator acknowledged the need for updated communication and documentation regarding new dialysis residents and their dietary needs.