Failure to Follow Fluid Restriction Orders for Dialysis Resident
Penalty
Summary
The facility failed to adhere to a physician-ordered fluid restriction for a resident receiving dialysis, resulting in the resident being given more fluids than prescribed on multiple occasions. The physician's order and care plan specified a strict fluid restriction of 1000cc per 24 hours, divided among the three nursing shifts. However, medication administration records showed that the resident received a total of 1420cc of fluid on several days, exceeding the prescribed limit. This discrepancy was confirmed during interviews with both a licensed vocational nurse and the director of nursing, who acknowledged that the physician's order was not being followed. The resident involved had diagnoses of end stage renal disease and generalized edema, and required dialysis as well as assistance with daily activities. The facility's policies on fluid restriction and dialysis management required strict adherence to physician orders, but these were not followed in practice. The failure to comply with the fluid restriction was documented through record reviews, staff interviews, and review of facility policies.