Failure to Follow Physician Orders for Fluid Restriction and Medication Administration
Penalty
Summary
The facility failed to follow physician orders for medication administration and fluid restrictions for three residents. One resident with diagnoses of congestive heart failure and acute respiratory failure had a physician order for a 2000 ml fluid restriction per 24 hours, divided between dietary and nursing, but there was no documentation that this restriction was followed. Another resident with hyponatremia had a physician order for a 1000 ml fluid restriction, also divided between nursing and dining, and again, there was no documentation that the fluid restriction was adhered to, as confirmed by the Nursing Home Administrator. A third resident with coronary artery disease, hypertension, and carotid artery stenosis had a physician order for Amlodipine 2.5 mg to be administered daily only if the systolic blood pressure was greater than 140 mm Hg. However, the Medication Administration Records for February, March, and April showed that the resident received Amlodipine multiple times when the systolic blood pressure was less than 140 mm Hg. These findings were confirmed through clinical record review and interviews with facility staff.