Failure to Communicate and Enforce Fluid Restrictions for Residents
Penalty
Summary
The facility failed to ensure that direct care staff were aware of and adhered to physician-ordered fluid restrictions for three residents with significant medical conditions, including cardiomyopathy, chronic kidney disease, cerebral palsy, hyponatremia, coronary artery disease, and schizophrenia. Despite clear physician orders and care plans specifying daily fluid restrictions for these residents, staff interviews revealed that nurse aides were not informed of these restrictions. Observations showed that residents had access to large cups of ice water at their bedsides, and care records indicated multiple instances where fluid intake exceeded the prescribed limits. In some cases, the Kardex and nurse aide census sheets did not include information about the fluid restrictions, further contributing to the lack of staff awareness. Additionally, documentation for at least one resident failed to show any monitoring of fluid intake, and staff interviews confirmed a general lack of knowledge regarding which residents were on fluid restrictions. The Director of Nursing and the Nursing Home Administrator acknowledged that fluid restriction orders should have been communicated to staff and confirmed the failure to do so. These lapses resulted in the facility not maintaining acceptable parameters of nutritional status for the affected residents, as required by facility policy and state regulations.