Failure to Assess and Manage CHF According to Physician Orders
Penalty
Summary
Facility staff failed to accurately assess and manage a resident's congestive heart failure (CHF) according to physician orders. The resident, who had diagnoses including CHF, COPD, and atrial fibrillation, was admitted with a care plan that required monitoring for changes in lung sounds, cough, edema, and weight. Physician orders specified that a diuretic (furosemide) should be administered if the resident's weight increased by two pounds in one day or if leg swelling developed, and that daily weights should be recorded with clinician notification for significant weight gain. Although daily weights were documented, staff did not administer the diuretic, as they only monitored for weight gain and were unaware that leg swelling was also an indication for the medication. Interviews and record reviews revealed that staff did not specifically assess or document the presence or absence of leg, ankle, or foot swelling, despite concerns raised by the resident's representative about swelling and weight gain. Nursing staff, including RNs and LPNs, confirmed they were not monitoring for edema as required by the physician's order and did not recognize that swelling alone should have prompted administration of the diuretic. The Director of Nursing also acknowledged that staff did not monitor or document swelling and was unaware of the full scope of the medication order.