032314 Phoenix Childrens Hospital- Dialysis Center

“PE-PT CARE ENVIRONMENT-SUFFICIENT SPACE CFR(s): 494.60(c)(1) The space for treating each patient must be sufficient to provide needed care and services, prevent cross-contamination, and to accommodate medical emergency equipment and staff. This Standard is not met as evidenced by: 49430 Based on observation and staff interviews, it was determined that the facility failed to ensure that the space for treating each patient is sufficient to provide needed care and services, prevent cross-contamination, and to accommodate medical emergency equipment and staff. 1. The dialysis chairs at stations #4 and #5 were housed within adequate space. Both chairs had multiple items placed closely around them; dialysis machines, trash cans, biohazard containers, treatment carts, infusion pumps and the patient’s personal items which has the high potential risk of staff not being able to perform any emergency medical treatment if needed, evacuate patients in a timely manor and cause cross contamination, which could result in potential patient death; and 2. The dialysis chairs at stations #4 and #5 were housed in adequate space to prevent potentially causing cross contamination between patients. Findings include: On 01/09/2024, at 09:30 am, the surveyor observed that the patient’s chair at station #4 was in the front, corner with the patient in a semi reclined position. To the left of the chair sat the patients parent seated in a folding chair. On the floor around the patients chair and parent’s chair were multiple bags and personal items within a 2 foot square area encompassing the area between the patient chair and wall. To the right of the patients chair was the patients dialysis machine, touching the reclined back of the chair. Directly in front of the dialysis machine, touching the machine, was the biohazard bin. The headrest of the reclined chair was touching the back wall/countertop. In front of the dialysis machine, less than 6 inches was the RN with the computer charting system. At the foot of the chair, less than 6 inches away was the treatment cart. All items needed to be moved/shuffled by staff in order to access the patient. These are needed items for the dialysis treatment but the space provided is not sufficient for safe access to the patient. Station #4 privacy curtain was pulled to provide privacy due to the location of the upper chest central venous catheter. The privacy curtain, of station #4, touches the patients chair and arm in station #5. Station #5 chair could not be moved or repositioned due to walls and needed equipment to perform dialysis in that station. Additional observations demonstrated staff squeezing between treatment carts, station chairs, dialysis machines, computer charting systems and biohazard bins to deliver care to patients. This increases the risk of cross contamination to patients. Employee #1 verified, in an interview conducted on 01/09/2024, at 10:00 am, that the chairs were so close together and surrounded by multiple necessary items that emergency care could not be performed in a timely manor, if needed.”

“MR-COMPLETE RECORDS PROMPTLY CFR(s): 494.170(b)(1) (1) Current medical records and those of discharged patients must be completed promptly. This Standard is not met as evidenced by: 49430 Based on review of medical records and staff interview, it was determined the facility failed to ensure the medical record for (8) of (9) patients contained a MD note and/or MD signed Interdisciplinary Care Plan, signed by the patient’s nephrologist within 30 days of required timeframe. Failure to ensure a patient’s physician completes and signs a monthly notes and care plans may disrupt continuity of patient care due to an incomplete medical record. Findings include: Patients #2, #3, #4, #5, #6, #7, #8 and #9 were missing MD signatures within 30 days of authored care plans/MD notes. Patient #2: Comprehensive Interdisciplinary Patient Assessment (CIPA) authored 10/05/2023. Signed by MD 11/27/2023. Patient #3: CIPA authored 10/05/2023. Signed by MD 11/27/2023. Patient #4: CIPA authored 10/10/2023. Signed by MD 11/27/2023. Patient #5: CIPA authored 08/18/2023. MD signed 10/03/2023. Patient #6: CIPA authored 10/06/2023. MD signed 11/22/2023 CIPA authored 11/10/2023. MD signed 12/12/2023. Patient #7: CIPA authored 10/06/2023. MD signed 11/27/2023 Patient #8: CIPA authored 10/10/2023. MD signed 11/22/2023. Patient #9: CIPA authored 12/07/2023. MD signed 01/09/2024. CIPA authored 11/22/2023. MD signed 01/09/2024. Employee #1 confirmed on 01/10/2024 that care plans and MD notes were missing MD signatures within 30 days of authored/written documents.”