| 24 |
KENTMERE REHABILITATION AND HEALTHCARE CENTER |
85001 |
1900 LOVERING AVENUE |
WILMINGTON |
DE |
19806 |
2018-12-06 |
692 |
D |
1 |
1 |
H65F11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, review of facility policy, and interview, it was determined that the facility failed to provide R15 fluids as per facility policy, family request and according to physician orders. A physician ordered to encourage fluids for 3 days on 11/30/18 after R15's BMP laboratory results revealed an elevated BUN. Findings include: The Facility Nursing policy entitled Hydration- Resident, effective (MONTH) (YEAR), stated, . 1. Unless otherwise ordered or contraindicated, residents will routinely be offered fluids during meals . and water will be provided at bedside (as appropriate) . 3. If a resident cannot select the required amount of recommended fluids, extra fluids shall be added to meet their goal. 4. Additional fluids are offered in the following methods: * Styrofoam cups (approx. 480 cc) filled with water every shift and kept at the bedside, or with the resident . * Medication pass . Cross- refer F770, example #3 Review of R15's EMR revealed the following: R15 was admitted to the facility in (YEAR). R15 has [DIAGNOSES REDACTED]. Review of R15's BUN's from 11/22/17 through 5/30/18 ranged from 39-48. 8/29/18- Review of R15's annual MDS assessment, coded R15 as a 3 for cognition (severly impaired- never/rarely made decisions). There were no significant weight gains or losses coded and R15 was able to eat/drink independently after set up help. R15 was coded as receiving diuretics or fluid pills (cause fluid loss daily). 3/2/17- R15's at risk for dehydration related to use of daily diuretic care plan listed interventions including but not limited to: encourage and assist resident as needed to consume 100% of liquids offered at all meals, offer a variety of liquids each shift, even during the night, offer extra fluids when giving medications if medically appropriate, provide an extra 240 cc fluid every shift, offer soup at both lunch and dinner, and evaluate resident for hydration needs. Even residents who are independent may need reminders to drink. 8/30/18- R15 had a physician's orders [REDACTED]. 11/12/18 nutrition risk assessment- estimated fluid needs 1659 ml. R15 's diet order was for a no added salt regular consistency diet with special instructions to receive soup with lunch and dinner. Listed under supplements was encourage po (oral) fluids, extra 240 ml q (every) shift. 11/28/18 12:13 PM- During a family interview with F8 (R15's daughter and POA), she stated that she would like her mother to be offered fresh water 3 times a day. F8 further stated that she's brought it to the facility's attention multiple times, including during care plan meetings. November (YEAR)- Review of R15's MAR included the 8/30/18 order for encourage oral fluids, extra 240 ml every shift. The majority of shifts, nursing documented 240 mls were consumed, however, 120 ml was consumed on 20 out of 90 shifts. 11/30/18- a BMP laboratory (lab) result was reviewed by a physician; R15's BUN was elevated at 47 (normal range 10-26). As a result of this, the physician wrote on the lab result Encourage fluids x (times) 3 days and Repeat BMP 12/3/18. There was no evidence in the (MONTH) or (MONTH) MAR, as of 12/5/18, that the order, dated 11/30/18, was added to the MARs and therefore, implemented. 12/3/18 10:55 AM- R15 had a large styrofoam cup beside the sink in her room. It was undated and felt about 1/2 full. 12/4/18 11:29 AM- R15 was asleep in bed. Unable to see cup in her room from the hallway. 12/5/18 12:35 PM- Findings were reviewed with E3 (ADON). E3 confirmed the orders handwritten onto R15's 11/30/18 BMP lab result for encourage fluids x 3 days was not entered into the EMR as a physician order [REDACTED]. When asked whose responsibility it was to ensure MD or NP orders were input to the EMR, E3 stated after the MD or NP signs the lab results, the unit manager or another nurse on the floor should review the signed lab result and put the order(s) in the EMR. 12/5/18 12:25 PM- R15 was observed sitting in a chair in her room with her lunch tray in front of her. She had eaten all of her soup and very little of what was on her plate. She had a full 8 ounce cup of coffee on her tray and a 4 ounce can of soda; there was still some soda in the can and there was a 4 ounce cup with soda that was 1/2 full. There was no styrofoam cup or any other types of cups in her room with water. 12/5/18 2:35 PM- Findings were reviewed with E2 (DON). 12/6/18 8:45 AM- E2 advised the surveyor that R15 was receiving extra fluids as per the MAR and stated that R15's BUN's had been in the 40's on numerous dates, so the 12/3/18 BUN was in the range of what R15's BUN's have been. Although R15 received extra fluids from the 8/30/18 physician order [REDACTED]. The facility failed to provide R15 fluids as per facility policy, family wishes and according to physician orders. Findings were reviewed on 12/6/18 at approximately 7:45 PM during the exit conference with E1 (NHA), E2 (DON), E3, and E14 (QA). |
2020-09-01 |