Failure to Monitor Residents on Diuretic Therapy
Penalty
Summary
Surveyors identified that the facility failed to ensure appropriate monitoring for residents receiving diuretic medications. For one resident with chronic kidney disease and an order for Furosemide, there were no laboratory orders or care plan interventions in place to monitor the effects of the medication. This was confirmed by a registered nurse who acknowledged the absence of monitoring orders. Another resident with chronic kidney disease and congestive heart failure was prescribed Torsemide, but there were no orders or documentation for monitoring the medication's effects, and the resident reported not having any blood tests while in the facility. The care plan referenced monitoring lab work and symptoms of hypokalemia, but no pharmacy recommendations or orders for monitoring were present. A third resident with congestive heart failure was prescribed Spironolactone, and while the care plan included interventions to monitor for hypokalemia and other lab values, there was no documentation in the medication administration record indicating that monitoring occurred. The registered nurse confirmed the lack of monitoring orders. The Director of Nursing stated that pharmacy recommendations for monitoring are made to the primary care provider, but it is ultimately up to the provider to order such monitoring. These findings demonstrate a lack of consistent monitoring for residents on diuretic therapy, as required by facility policy and regulatory standards.