Failure to Maintain Dialysis Fluid Restrictions and Access Site Monitoring
Penalty
Summary
The facility failed to provide safe and appropriate dialysis care for a resident with end stage renal disease who required hemodialysis and a strict fluid restriction. Despite physician orders specifying a daily fluid restriction of 1200cc, with detailed breakdowns for dietary and nursing staff, the resident repeatedly received fluids in excess of the prescribed limit on multiple days. Documentation showed that the resident's fluid intake exceeded the ordered amount on at least ten occasions, and there was no evidence that the physician reviewed these overages or that the resident or staff were educated on the importance of adhering to the fluid restriction as outlined in the care plan. Additionally, the facility did not ensure that orders were in place to monitor the resident's dialysis access site for bleeding, infection, or erosion, nor were there orders to change the dressing as required. The Medication Administration Record lacked documentation of the total fluid intake for certain days, and interviews with staff confirmed gaps in monitoring and documentation. The Director of Nursing and Nursing Home Administrator acknowledged these failures, confirming that the facility did not maintain the resident's fluid restriction as ordered and did not have appropriate orders or monitoring in place for the dialysis access site.