Usrc Denali Dialysis

“IC-WEAR GLOVES/HAND HYGIENE CFR(s): 494.30(a)(1) Wear disposable gloves when caring for the patient or touching the patient’s equipment at the dialysis station. Staff must remove gloves and wash hands between each patient or station. This Standard is not met as evidenced by: 43792 . Based on observation, interview and record review, the facility failed to ensure 2 patients (#’s 7 and 8) out of 2 patients with Access of Arteriovenous (AV) Fistula or Graft sites (a surgically created access site where needles can be inserted for blood to flow through a dialysis machine which filers the blood for waste and toxins), were monitored to ensure hand hygiene and the washing of access sites prior to starting hemodialysis treatments occurred. This failed practice placed the patients at risk for infection. Findings: During an observation on 9/5/24 at 10:46 AM, Patient (Pt) #7 was observed entering the treatment room from the waiting room. The patient weighed on the scale in the front of the treatment area and was escorted to his/her treatment chair. The patient was not observed to wash his/her hands or cleanse the Left lower arm fistula site upon entering the treatment area and proceeding to the treatment station. After seating Patient #7 in the dialysis chair and exposing his/her Left lower arm fistula area, Patient Care Technician (PCT) #2 proceeded to locate and palpate the needle cannulation sites prior to skin disinfection. PCT #2 removed his/her gloves and donned clean gloves prior to disinfecting the access sites and cannulating the patient with two access needles. Pt #7 was not observed to have washed his/her hands or the fistula access site upon entering the treatment room or observed to have been asked by PCT #2 if Pt #7 had washed his/her hands or access site prior to initiation of the hemodialysis treatment. During an interview on 9/5/24 at 11:20 AM, PCT #2 stated, when asked if he/she had reminded or asked Pt #7 if she/he had washed his/her hands upon entering the treatment room and washed the access site, that this had not occurred. Patient #8 During an observation on 9/5/24 at 11:00 AM, Pt #8 was observed entering the treatment room from the waiting room. The patient weighed on the scale in the front of the treatment area and was escorted to his/her treatment chair. The patient was nor observed to wash his/her hands or cleanse the right arm fistula area upon entering the treatment area and proceeding to the treatment station. After seating Pt #8 in the dialysis chair and exposing his/her right upper arm fistula area, PCT #3 proceeded to locate and palpate the needle cannulation sites prior to skin disinfection. PCT #3 removed his/her gloves and donned clean gloves prior to disinfecting the access sites and cannulating the patient with two access needles. Pt #8 was not observed to have washed his/her hands or the fistula access site upon entering the treatment room or observed to have been asked by PCT #3 if Pt #8 had washed his / her hands or access site prior to initiation of the hemodialysis treatment. During an interview on 9/5/24 at 11:15 AM, PCT #3 stated, when asked if he/she had reminded or asked Pt #8 if she/he had washed his/her hands upon entering the treatment room and washed the access site, that this had not occurred. During a phone interview on 9/5/24 at 3:30 PM, the Medical Director stated the patients should be asked and reminded to wash their hands and access sites before initiation of dialysis by the staff. Review of the facility’s policy “Assessment and Cannulation for AV Fistula/Graft and Patient Self Cannulation,” dated 10/2023, revealed “PURPOSE: To provide guidelines for successful cannulation of new and existing arteriovenous fistulas and grafts ... Procedure: Established AVF ... Patient must wash access with soap and water prior to disinfection and cannulation.” Review of the facility’s policy “Infection Control and Precautions for all Patients,” dated 7/2023 revealed, “Patients and visitors must perform hand hygiene before and after entering patient treatment area.””

“MR-COMPLETE, ACCURATE, ACCESSIBLE CFR(s): 494.170 The dialysis facility must maintain complete, accurate, and accessible records on all patients, including home patients who elect to receive dialysis supplies and equipment from a supplier that is not a provider of ESRD services and all other home dialysis patients whose care is under the supervision of the facility. This Standard is not met as evidenced by: 43792 Based on record review, observation, and interview, the facility failed to maintain accurate and complete medical records for 3 active medical records (#’s 2, 7, and 8) out of 8 sampled medical records. Specificaly, one record failed to include progress notes of a patient’s transient move to another clinic, and two records failed to include accurate handwashing documentation prior to patients’ initiation of dialysis during pre-access care. This failed practice had the potential to decrease the facility staffs’ understanding of the medical history, the care provided and needed, and potential treatment outcomes for the patients. Findings: Patient #2 Record review on 9/5/24 at 10:00 AM revealed Patient (Pt) #2 was admitted on 5/16/22 with a diagnosis of End Stage Renal Disease. The record failed to include documentation that the patient had been transferred on a short term basis to a nearby clinic. The patient’s last dialysis treatment at this facility was 7/15/24, 12:11 PM - 4:15 PM. There was no documentation in the record about the patient’s transfer to another clinic in this record. During an interview on 9/5/24 at 12:16 PM, the Social Worker stated that there was no documentation in the record of the patient’s temporary transfer. This patient had not returned to this facility. Patient #7 During an observation on 9/5/24 at 10:46 AM, Pt #7 was observed entering the treatment room from the waiting room. The patient weighed on the scale in the front of the treatment area and was escorted to his/her treatment chair. After seating Patient #7 in the dialysis chair and exposing his/her left lower arm fistula area, Patient Care Technician (PCT) #2 proceeded to locate and palpate the needle cannulation sites prior to skin disinfection. PCT #2 removed his/her gloves and donned clean gloves prior to disinfecting the access sites and cannulating the patient with two access needles. Pt #7 was not observed to have washed his/her hands or the fistula access site upon entering the treatment room or observed to have been asked by PCT #2 if Pt #7 had washed his / her hands or access site prior to initiation of the hemodialysis treatment. During an interview on 9/5/24 at 11:20 AM, PCT #2 stated, when asked if he/she had reminded or asked Pt #7 if she/he had washed his/her hands upon entering the treatment room and washed the access site, that this had not occurred. Review of Patient #7’s Hemodialysis Flow Sheet, dated 9/5/24 at 4:44 PM revealed Pre-Access care was performed by PCT #2 at 10:53 AM and included the statement: Patient Handwashing “Yes.” During an observation on 9/5/24 at 11:00 AM, Pt #8 was observed entering the treatment room from the waiting room. The patient weighed on the scale in the front of the treatment area and was escorted to his/her treatment chair. After seating Pt #8 in the dialysis chair and exposing his/her right upper arm fistula area, PCT #3 proceeded to locate and palpate the needle cannulation sites prior to skin disinfection. PCT #3 removed his/her gloves and donned clean gloves prior to disinfecting the access sites and cannulating the patient with two access needles. Pt #8 was not observed to have washed his/her hands or the fistula access site upon entering the treatment room or observed to have been asked by PCT #3 if Pt #8 had washed his / her hands or access site prior to initiation of the hemodialysis treatment. During an interview on 9/5/24 at 11:15 AM, PCT #3 stated, when asked if he/she had reminded or asked Pt #8 if she/he had washed his/her hands upon entering the treatment room and washed the access site, that this had not occurred. Review of Patient #8’s Hemodialysis Flow Sheet, dated 9/5/24 at 4:44 PM, revealed Pre-Access care was performed by PCT #3 at 11:04 AM and included the statement: Patient Handwashing “Yes.” During a phone interview on 9/5/24 at 3:30 PM, the Medical Director stated the patients should be asked and reminded to wash their hands and access sites before initiation of dialysis by the staff. During an interview on 9/5/24 at 4:45 PM, the Clinic Manager stated the PCTs had just been clicking and these handwashing notes were not accurate for Patient #7 and #8’s hemodialysis flowsheets. Review of the facility’s policy “Electronic Medical Records Application” revision date 2/2024 revealed “Treatment Flowsheets: completed for each patient treatment ... Refer to General Guidelines for Medical Records in policy C-AD-0440 Medical Records.” Review of the facility’s policy “Assessment and Cannulation for AV Fistula/Graft and Patient Self Cannulation,” dated 10/2023, revealed “PURPOSE: To provide guidelines for successful cannulation of new and existing arteriovenous fistulas and grafts ... Procedure: Established AVF ... Patient must wash access with soap and water prior to disinfection and cannulation.” Review of the facility’s policy “Infection Control and Precautions for all Patients,” dated 7/2023 revealed, “Patients and visitors must perform hand hygiene before and after entering patient treatment area.” Review of the facility’s policy “Patient Rights and Responsiblities” revision date 2/2023 revealed, “The right to - receive the necessary services required by the regulations regarding the patient plan of care. This includes the right to receive individualized care as determined by the interdisciplinary team ....””