Failure to Implement Hydration Care Plan for Dependent Resident
Penalty
Summary
A deficiency occurred when the facility failed to implement a comprehensive care plan for a resident identified as being at high risk for dehydration. Multiple observations over several days revealed that the resident, who was non-verbal, totally dependent for eating and drinking, and unable to request or obtain fluids independently, did not have hydration or fluids readily available at the bedside during several checks. The resident was also observed attending activities without being offered fluids, and a marked water cup in the resident's room showed no change in water level, indicating fluids were not being consumed or offered as needed. The resident's medical record documented significant diagnoses, including quadriplegia, pneumonitis, moderate protein-calorie malnutrition, dementia, chronic kidney disease, and chronic urinary tract infections (UTIs). The care plan addressed the need for assistance with activities of daily living (ADLs) and feeding, as well as monitoring for changes related to UTIs, but did not include a specific focus or interventions for dehydration risk. A quarterly risk assessment and MDS confirmed the resident's total dependence and high risk for hydration issues, yet there was no care plan focus or physician order to encourage or offer fluids every two hours as would be expected for such a resident. Interviews with staff confirmed that the resident required total assistance and could not hold a cup or request fluids. Staff acknowledged the expectation to offer fluids to residents at risk for dehydration, especially those with recurrent UTIs, but there was no evidence in the medical record or care plan that these interventions were implemented. Additionally, the facility was unable to provide a dehydration policy when requested.
Plan Of Correction
1) Resident #58's plan of care updated to reflect at risk for dehydration on 8/5/2025 with appropriate interventions. 2) An audit of current residents' quarterly hydration risk evaluation was conducted on 08/20/2025 by the Director of Nursing, Nurse Management team, or designee to verify residents to be at risk for dehydration. Care plan reviews with intervention updated to include providing necessary assistance, encouragement, and offering of fluids throughout shift, as clinically indicated. 3) An in-service education was conducted on 08/19/2025 by the Administrator, Director of Nursing, or designee with all licensed/registered nurses addressing the significance of hydration risk evaluation completed on admission, quarterly, and/or significant change, and the implementation of a plan of care for a resident at risk for dehydration. 4) The nursing management team, Registered Dietitian, and/or Dietary Manager will review each resident with risk factors for dehydration to ensure appropriate interventions are implemented and an updated plan of care is complete. The Director of Nursing (DON), or designee, will complete five (5) random weekly chart audits for six (6) consecutive weeks to review quarterly hydration risk evaluations and verify that appropriate interventions have been put in place to reduce the risk of dehydration. Audits will assure that care plans remain updated to reflect these interventions. The results of the audit will be forwarded to the Quality Assurance Committee for review monthly for at least three months with a goal of 100% compliance. Upon completion and 100% compliance for at least three months is achieved, frequency of further review and ongoing need for review will be determined by the QAPI committee. The results of the audit will be forwarded to the Quality Assurance Committee for review monthly for at least three months with a goal of 100% compliance. Upon completion and 100% compliance for at least three months is achieved, frequency of further review and ongoing need for review will be determined by the QAPI committee.