Failure to Enforce Physician-Ordered Fluid Restriction
Penalty
Summary
Staff failed to follow a physician-ordered fluid restriction for a resident with a history of congestive heart failure, respiratory failure, and hypertension. The resident was on a 2000 ml per 24-hour fluid restriction, with specific allocations for dietary and nursing staff, and was not to have a bedside water pitcher. Despite these orders, review of the Treatment Administration Records showed that the fluid restriction was exceeded on multiple days across three consecutive months. The facility's policy required nursing and dietary departments to collaborate and document fluid intake, but this was not consistently adhered to. Interviews with staff revealed that the resident, a former director of nursing at the facility, was aware of her fluid restriction but did not always comply, and staff acknowledged that she would often drink more than allowed. Staff statements indicated that the resident's prior professional role influenced her behavior and the staff's response, with several staff members noting her tendency to disregard the restriction. The facility's policy outlined the process for managing fluid restrictions, but the failure to enforce and document compliance led to the deficiency.