Failure to Follow Physician Orders for Fluid Restriction and Medication Administration
Penalty
Summary
The facility failed to follow physician orders regarding fluid restriction and medication administration for a resident with multiple diagnoses, including congestive heart failure, diabetes mellitus, urinary retention, and chronic obstructive pulmonary disease. The physician had ordered a strict 2000 cc fluid restriction, with specific allocations for dietary and nursing shifts. However, clinical record review showed that on multiple dates, the resident's fluid intake exceeded the ordered restriction, with daily totals ranging from 2090 cc to 2960 cc, surpassing the prescribed limit on numerous occasions. Additionally, the facility did not adhere to the physician's order for the administration of Midodrine, a medication intended to be held if the resident's systolic blood pressure was greater than 120 mmHg. Medication administration records revealed that the resident received Midodrine on several occasions when their systolic blood pressure was above the specified threshold. These findings were confirmed during interviews with the Nursing Home Administrator and Director of Nursing, who acknowledged that physician orders for both fluid restriction and medication administration were not being followed for this resident.