Failure to Monitor and Provide Fluids per Provider Orders for Residents with Fluid Restrictions
Penalty
Summary
The facility failed to properly monitor and provide fluids according to provider orders for two residents with fluid restrictions. For one resident with a history of spinal fracture, chronic kidney disease, and diabetes, provider orders specified a 1200 cc fluid restriction, with specific amounts to be provided by nursing and dietary staff. Observations revealed that the resident was given more fluids than allowed, and staff were unaware of the fluid restriction. Documentation of fluid intake was inconsistent and inaccurate, with daily totals not matching the amounts provided by nursing and dietary staff. Additionally, required signage indicating the fluid restriction was not posted at the resident's bedside, and meal trays contained more fluid than permitted by the restriction. For the second resident, who had dementia and diabetes, provider orders indicated a 2000 cc fluid restriction. Observations showed a full water pitcher at the bedside, and documentation of fluid intake was again inconsistent and inaccurate, with daily totals not aligning with the actual amounts provided. Meal tickets for both residents instructed staff to provide more fluid than the restrictions allowed, and the registered dietician confirmed that the meal tickets did not reflect the correct fluid restrictions. Interviews with staff, including a CNA, unit manager/LPN, registered dietician, and the DON, revealed a lack of awareness and adherence to the fluid restriction orders. Staff were unclear about which residents were on fluid restrictions, and the process for totaling and monitoring fluid intake was not followed as ordered. The facility did not ensure that residents with fluid restrictions received the correct amount of fluids as prescribed by their providers.