Failure to Obtain Ordered Weights and Dialysis Access Assessments
Penalty
Summary
The deficiency involves the facility’s failure to ensure services met professional standards by not obtaining ordered weights for two residents and not securing timely physician orders for hemodialysis assessments for another resident. For one resident admitted with diagnoses including moderate protein calorie malnutrition, dementia, seizures, and muscle weakness, the physician ordered weekly weights from admission for four weeks, then monthly. The facility’s weight monitoring policy required weights on admission and weekly for four weeks for new admissions. Record review showed weights documented on two dates after admission, but no admission weight was recorded. The resident’s care plan identified a nutritional problem with moderate protein malnutrition and dysphagia and included an intervention to monitor weight as indicated, but the admission weight was missing. For a second resident with an initial admission, subsequent discharge, and readmission, diagnoses included dementia, muscle weakness, intellectual disabilities, schizoaffective disorder, moderate protein calorie malnutrition, dysphagia, and difficulty walking. There was an order for weekly weights from admission for four weeks, then monthly. The care plan identified a nutritional problem with a goal to maintain adequate nutritional status as evidenced by maintaining weight and included providing and serving diet as ordered. Weight records showed values on the initial admission date and subsequent dates, but there was no weight documented at the time of readmission, despite staff interviews indicating that residents should be weighed on admission and upon return from the hospital to establish a new baseline. The facility also failed to ensure physician’s orders for hemodialysis-related assessments were in place for a resident receiving dialysis. This resident was cognitively intact and had multiple diagnoses including anemia, heart failure, hypertension, kidney failure, diabetes, hyperlipidemia, anxiety, depression, bipolar disorder, and asthma, and received dialysis. The care plan for dialysis focused on minimizing complications and included interventions such as checking and changing the dressing at the access site daily, monitoring vital signs before and after dialysis, monitoring and documenting edema and weight gain, and monitoring for signs and symptoms of infection and renal insufficiency. The physician orders included renal care on specific days, maintaining a clean, dry, intact dialysis dressing, and, starting on a later date, orders to monitor the access site for bruising, bleeding, infection, and to assess for thrill and bruit every shift. Review of order history showed no prior physician orders to monitor the access site or assess for thrill and bruit before that later date. The resident reported that staff did not complete assessments after dialysis and had never checked the bruit and thrill, and the DON stated she expected such orders and assessments to be in place but could not explain why they were not ordered earlier.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.