Long-Term Care Survey Alert

What if a resident isn’t ingesting her calculated  “cc” requirements but seems OK? Will surveyors  jump on you if you get rid of the water pitchers  that residents never seem to use in favor of a hydration  cart and station?

In answering these questions posed by nurses  attending the June NADONA conference, surveyor  Stephanie Williams with the Centers for Medicare  & Medicaid Services noted that residents’ actual  fluid requirements reflect many factors, including their weight, activity levels and clinical condition.  Staff should look at the “whole picture” to see if  the resident who doesn’t seem to be   meeting her  fluid quota shows any signs of dehydration. And a  resident may be getting more fluid than staff realizes  from foods such as gelatin, ice cream and foods  with high-fluid content.

“In addition, some people say they have never  been ‘drinkers’ in terms of consuming that much water  or other fluids,” Williams said.

Williams didn’t appear too keen on the idea  of foregoing water pitchers in residents’ rooms even  when the facility implements hydration stations or  carts. She noted that some facilities are going to  smaller pitchers that residents can lift more easily.  Even though the pitchers need to be filled more often,  residents are more likely to pour their own fluids  and drink without staff assistance.

Laura Fain, DON for Leesburg Regional  Medical Center, Nursing Center in Leesburg, FL,  agrees. “Otherwise, you can’t ensure residents have  access to water when they are thirsty,” she tells Eli.

Williams reported that some facilities are  equipping chairs with cups in holders and constantly  topping off residents’ fluids when the residents are  out of their rooms.