Failure to Notify APRN and Family of Significant Weight Changes
Penalty
Summary
The facility failed to notify the Advanced Practice Registered Nurse (APRN) of a significant weight gain in a resident with congestive heart failure (CHF). The resident, who had diagnoses including COPD, chronic kidney disease, and CHF, was to be weighed weekly with instructions to notify the physician or APRN if there was a weight gain of 2 pounds or more in a day or 5 pounds or more in a week. Despite a documented weight gain of 7.7 pounds in one week, there was no evidence in the nursing notes or clinical record that the APRN was informed of this change. The APRN confirmed she was not notified and would have investigated the cause if she had been made aware. Nursing staff described inconsistent practices regarding weight monitoring and communication, with some confusion about shift responsibilities and documentation in the APRN communication book. Additionally, the facility failed to notify the family or responsible party of a significant weight loss in another resident who was admitted with diagnoses including failure to thrive, protein-calorie malnutrition, and dementia. This resident experienced a weight loss of 9.9 pounds in one week and a total of 22.7 pounds over two weeks. The care plan included monitoring for nutritional status and weighing per physician orders. Despite documentation of the weight loss by the dietician, there was no evidence that the family was notified. Interviews revealed confusion among staff regarding who was responsible for family notification, with the dietician believing it was nursing's responsibility and the Director of Nursing stating it was the dietician's role. The facility policy indicated the dietician should discuss undesired weight loss with the family, but this did not occur. Both deficiencies were identified through review of clinical records, facility documentation, and staff interviews. The failures were contrary to physician orders and facility policies, which required timely notification of significant changes in resident condition to the appropriate medical provider and family members.