Failure to Adhere to Fluid Restriction Orders for Dialysis Resident
Penalty
Summary
The facility failed to follow physician orders for fluid restriction for a resident undergoing dialysis. The resident had a documented fluid restriction order of 1500 cc per day, with specific amounts to be provided by dietary and nursing staff each shift. The resident's care plan identified a risk for dehydration due to fluid restrictions and other medical conditions, and included interventions such as monitoring intake and providing fluids as ordered. Despite these orders and care plan interventions, observations revealed that the resident had access to a 20-ounce cup of water at her bedside on multiple occasions, with staff interviews indicating inconsistent practices regarding the provision and monitoring of fluids. One staff member stated that fluids are routinely refreshed at the end of the night shift and again at breakfast, while another staff member reported not providing fluids at the bedside due to the fluid restriction order. The resident was cognitively intact and aware of her fluid restriction, stating she needed to monitor her intake due to dialysis. Staff interviews revealed a lack of consistent adherence to the fluid restriction order, with some staff attributing excess fluids at the bedside to the resident's own actions or noncompliance. The facility's policy on fluid restrictions did not address fluids provided by staff for hydration, contributing to inconsistent implementation of the restriction. These actions and inactions resulted in the facility's failure to ensure the resident's fluid intake was properly restricted and monitored as ordered.