Failure to Timely Implement Therapeutic Diet and Fluid Restriction
Penalty
Summary
The facility failed to ensure that a resident with significant medical conditions, including heart failure, end stage renal disease, and dependence on renal dialysis, was provided with a timely and appropriate therapeutic diet and fluid restriction as ordered by the healthcare provider. Documentation showed that after returning from dialysis, the resident had new orders for fluid restriction, but there was a delay in entering and implementing these orders. The physician's order for a 1500 cc fluid restriction was not entered until several days after the dialysis visit, and the care plan referenced the need for dietary interventions related to fluid overload, but timely action was not taken. Interviews with facility staff revealed gaps in communication and follow-up regarding the new diet and fluid restriction orders. The DON stated that new orders from dialysis should be referred to dietary and followed up by the next day, but this process was not completed as required. The physician and consultant dietician both indicated uncertainty about the delay and the process for implementing the orders. Additionally, there was a lack of documentation and follow-up from nursing staff involved in the resident's care, and the facility's policy emphasized the need for resident-centered care in accordance with professional standards, which was not met in this instance.