Failure to Follow Fluid Restriction and Notify Physician for Dialysis Resident
Penalty
Summary
The deficiency involves the facility’s failure to follow a physician’s fluid restriction order and to notify the physician of excessive fluid intake for a resident receiving dialysis. The resident had diagnoses including type 2 DM, ESRD, and dependence on dialysis, and had a physician’s order dated 12/19/25 for a 1000 cc/day fluid restriction, with 600 cc to be provided by Dietary (240 cc at breakfast, 120 cc at lunch, 240 cc at dinner) and 400 cc by Nursing (100 cc on night shift, 180 cc on day shift, 120 cc on evening shift). Review of the resident’s daily intake records showed multiple days on which the resident’s fluid intake exceeded the ordered 1000 cc, including intakes such as 1260 cc, 1460 cc, 1740 cc, and other amounts above the prescribed limit on various dates. There was no documentation in the medical record that the physician had been notified about these episodes of excessive fluid intake. During observation and interview, the resident stated he was on a fluid restriction, was not receiving food or drink from outside, and reported having no difficulty obtaining drinks from facility staff. An LVN acknowledged that the resident was on fluid restriction but usually consumed more than ordered on the day shift due to an additional 240 cc of hot chocolate in the morning, and further acknowledged that the fluid restriction order should be followed and the physician should be notified of excessive intake. The Director of Staff Development confirmed the record findings and stated staff should follow the fluid restriction order and notify the physician of excessive fluid intake. Review of facility policies on encouraging and restricting fluids, change in a resident’s condition or status, and care of residents with ESRD showed expectations that residents receive the amount of fluids necessary to maintain optimum health, that physicians be promptly notified of changes in condition or status, and that ESRD residents be cared for according to recognized standards of care.
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