Failure to Follow CHF Fluid Management Orders and Daily Weight Monitoring
Penalty
Summary
The deficiency involves the facility’s failure to follow physician orders for CHF-related fluid management, including daily weights and use of compression stockings, for three residents. One resident with CHF and bilateral lower extremity non-pitting edema reported that nursing staff were supposed to obtain daily weights but that this had not been done recently. The RN confirmed that this resident’s CHF management required a fluid restriction and daily weights with MD/NP notification for specified weight gains. The resident’s orders and care plan included daily weights with parameters for provider notification, yet the January 2026 weight record showed missing daily weights on multiple dates. The DON stated that staff were expected to follow CHF orders, including daily weights and application of edema compression stockings. Another resident with chronic lower extremity edema related to CHF was repeatedly observed on different days wearing regular ankle socks with shoes or slippers instead of compression stockings. An RN stated this resident required compression stockings for edema management, was dependent on staff to apply them, and that nurses were expected to follow the physician’s order to apply compression stockings in the morning and remove them at night. A third resident with CHF and generalized lower extremity edema had an active order and care plan for daily weights with MD/NP notification for specified weight gains, but the January 2026 weight record showed multiple days without recorded daily weights. The facility’s weight monitoring policy required assessment of weight and fluid status and development of individualized care plans based on professional standards, but the documented omissions in daily weights and failure to apply ordered compression stockings demonstrate that these orders and care plan interventions were not consistently implemented.
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