Failure to Monitor and Maintain Adequate Hydration Leading to Hospitalization
Penalty
Summary
A deficiency occurred when the facility failed to ensure that a resident maintained acceptable parameters of nutritional status, specifically regarding hydration. The resident, who had multiple diagnoses including Parkinson's disease, anemia, hypo-osmolality, hyponatremia, chronic kidney disease, congestive heart failure, and hypertension, was assessed to require 2,350 cc of fluids per day. Despite this, fluid intake records showed that the resident consistently received less than the estimated daily fluid needs on nearly all documented days, with only one day meeting the requirement. The care plan did not address the resident's risk for dehydration, and there was no evidence of a dehydration assessment, comprehensive RN assessment, or provider notification when fluid goals were not met. Staff interviews revealed a lack of clarity and responsibility regarding monitoring fluid intake for residents not on fluid restrictions. The RN stated that fluid intake was only monitored for residents on fluid restrictions, and was unaware of how to identify residents at risk for dehydration through care plans or Kardex. The DON indicated that all residents are at risk for dehydration but was unsure who was responsible for ensuring fluid goals were met, suggesting the dietician was responsible but also expressing uncertainty about the process. There was no documentation that the dietary manager or registered dietitian was notified when the resident failed to meet fluid needs over multiple days. The resident experienced a significant change in condition, including altered mental status, lethargy, increased confusion, increased shaking, and weakness, leading to hospitalization. Emergency department records documented the resident as unresponsive, hypothermic, and dehydrated, with abnormal laboratory values indicating dehydration and renal impairment. The resident was treated with IV fluids and admitted to the hospital, later returning to the facility on hospice care and subsequently passing away. The failure to monitor and address the resident's hydration status directly resulted in hospitalization for dehydration.