Failure to Ensure Adequate Hydration for Dependent Resident
Penalty
Summary
A deficiency occurred when the facility failed to ensure that a resident was offered sufficient fluids to maintain proper hydration, despite being at risk due to impaired mobility, use of diuretic medication, and a recent history of acute kidney injury (AKI) and urinary tract infection. The resident was dependent on staff for all activities of daily living, including eating and drinking, and had a documented recommended daily fluid intake of 1724-2155 mL. However, daily fluid intake records consistently showed significantly lower amounts, with intake often less than half of the recommended minimum. Staff and clinical documentation confirmed awareness of the resident's poor intake, but there was no evidence of effective interventions or provider consultation to address the ongoing dehydration risk. The resident's clinical record and interviews revealed that staff encouraged fluid intake but did not implement or document additional interventions to increase hydration or consult with the provider regarding the resident's decreased intake. The dietician addressed nutritional needs but did not address hydration status or provide suggestions to improve it. As a result, the resident was transferred to the hospital with diagnoses of metabolic acidosis, hypokalemia, and AKI, with lab values indicative of severe dehydration. The lack of monitoring and timely intervention directly contributed to the resident's harm.