Failure to Administer Dialysis Medications and Enforce Fluid Restrictions
Penalty
Summary
The facility failed to ensure that residents requiring dialysis received services consistent with professional standards of practice, specifically regarding the administration of Sevelamer Carbonate and adherence to fluid restrictions. For two residents with chronic kidney disease on dialysis, physician orders specified Sevelamer Carbonate to be administered three times daily with meals and set strict daily fluid restrictions. Medication Administration Records (MAR) revealed multiple missed doses of Sevelamer for both residents, often documented as the resident being absent or with no evidence of administration at the scheduled times. Additionally, records showed that both residents exceeded their prescribed fluid intake on several occasions, surpassing the limits set by their physicians. Resident interviews confirmed that the medication was not consistently administered as ordered, with one resident stating that Sevelamer was usually not given before meals as prescribed. The Director of Nursing Services was unable to provide evidence that the medication was administered as ordered or that fluid restrictions were consistently followed. These findings were based on record reviews, resident and staff interviews, and direct observation of facility documentation.