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Based on interview and record review the facility failed to ensure nursing staff administered Intravenous (IV) fluids as ordered by the physician for one (#1) of 2 patients reviewed for medication administration out of a total sample of 10, resulting in the potential for less than optimal outcomes for patient #1. Findings include:

A review of the medical record for patient #1 was conducted with Staff E on 6/7/2021 at 1315 and the following was revealed:
Patient #1 was a 65 year-old female admitted to the facility on 3/31/2021 for rehabilitation.
According to the History and Physical (H&P), dated 3/31/2021 the patient presented to the facility with lower extremity weakness and back pain secondary to the spread of cancer (Thoracic and Lumbar Spine metastasis, left paraspinal mass and T9 vertebral body fracture).

Review of physician progress notes dated 4/2/2021 at 0916, revealed the patient reported some mild dizziness while attending therapy, and had a low blood pressure of 94/55. The physician noted: "patient had orthostatic hypotension likely secondary to dehydration as the patient had a poor liquid intake; No IV in and patient requested to attempt to increase her oral fluid intake."
The physician additionally noted, "patient was persistently tachycardic with likely dehydration and will start gentle hydration today and monitor.

Review of physician's orders for patient #1, dated 4/2/2021 at 1629 included Sodium Chloride (NaCl) 0.9 percent (%) IV now at 75 milliliters (ml) per hour. The order was discontinued on 4/5/2021 at 1601.

Review of the patient's (#1's) Medication Administration records (MAR's) dated 4/2/2021 through 4/5/2021 revealed the patient's initial IV solution (0.9 NaCl at 75 ml) was administered on 4/2/2021 at 2000. The patient's second IV solution was documented as given on 4/3/2021 at 2342. 23 hours after the initial bag.

Review of the intake and output (I&0) flow sheets revealed the patient (#1) received the following amount of 24 hour IV solutions:
On 4/2/2021: 26.25 ml.
On 4/3/2021: 675 ml.
On 4/4/2021: none recorded.

On 6/7/2021 at approximately 1400 Staff E was queried regarding the frequency of administering IV solutions at 75 ml per hour. Staff E replied, at 75 ml an hour that would entail 1800 ml in a 24 hour period. At that time she confirmed, that was not done. She said it may have been given but it's not documented.