Failure to Monitor and Enforce Fluid Restriction for Dialysis Resident
Penalty
Summary
A deficiency occurred when the facility failed to implement a process to ensure accurate accounting of daily fluid intake for a resident on dialysis with a physician-ordered fluid restriction. The resident had a documented order limiting fluid intake to 1500 cc per day, with specific allocations for dietary and medication administration. During observation, the resident was found with multiple bottled waters, a six-pack of soda, and a lidded cup of water in her room, and was seen drinking from one of the bottles. The resident confirmed she had been advised by her medical provider to limit fluid intake. Staff interviews revealed that while the resident was listed as having a fluid restriction in the huddle book, excess fluids were not consistently removed from her room, particularly after returning from dialysis when unused bottled water was brought back and left in her room. Further review showed that the resident's fluid restriction order had not been added to her treatment administration record (TAR), and her daily fluid intake was not being calculated or monitored as required. The facility's policy stated that fluid intake should be recorded on the medication record and that water should not be provided at the bedside unless included in the daily restriction or specifically ordered. The director of nursing acknowledged that the facility's processes for tracking and limiting the resident's fluid intake were not followed, and unnecessary fluids were not removed from the resident's room.