Davita Tucson Central 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: 37489 Based on document review, observation, and interview, it was determined that the facility failed to ensure staff changed gloves and performed hand hygiene between glove changes, between clean and dirty tasks, and when gathering dialysis supplies from clean supply carts. Failure to follow established standard and infection control precautions poses an increased risk of infections for immunocompromised patients through contact transmission and cross contamination. Findings include: The facility policy titled “INFECTION CONTROL FOR DIALYSIS FACILITIES” requires: “...Hand Hygiene...All teammates...will perform hand hygiene...prior to gloving and immediately after removal of gloves...after contamination with blood or other infectious material...after patient and dialysis delivery system contact...before touching clean areas such as supplies, supply cart and chairside keyboard/mouse...Use of an alcohol-based hand rub may be substituted for handwashing....” Observation on 03/06/2024 revealed PCT #10 providing patient care and preparing to cannulate Patient #9’s vascular access. PCT #10 stopped disinfecting the access halfway through the procedure, left the dialysis station, gathered sterile gauze and skin disinfectant from the clean supply area, and returned to the dialysis station and continued with the access disinfection and cannulation procedure. PCT #10 did not remove his/her gloves and perform hand hygiene upon stepping away from the dialysis station and upon gathering additional gauze and ExSept skin disinfectant, or change gloves and hand sanitize and reglove upon returning the dialysis station and continuing patient care. Employees #1 confirmed on 03/06/2024 that staff failed to follow the facility policy for hand hygiene and glove changes between clean and dirty tasks.”

“IC-IF TO STATION=DISP/DEDICATE OR DISINFECT CFR(s): 494.30(a)(1)(i) Items taken into the dialysis station should either be disposed of, dedicated for use only on a single patient, or cleaned and disinfected before being taken to a common clean area or used on another patient. -- Nondisposable items that cannot be cleaned and disinfected (e.g., adhesive tape, cloth covered blood pressure cuffs) should be dedicated for use only on a single patient. -- Unused medications (including multiple dose vials containing diluents) or supplies (syringes, alcohol swabs, etc.) taken to the patient’s station should be used only for that patient and should not be returned to a common clean area or used on other patients. This Standard is not met as evidenced by: 37489 Based on document review, observation, and interview, it was determined that the facility failed to ensure staff thoroughly cleaned and disinfected their stethoscope after use which has the potential for cross contamination and increased infection. Findings include: The facility policy titled “Infection Control for Dialysis Facilities” requires: “...Notes: Refer to the Infection Control Quick Reference Guide for further detail on implementation steps...Non-disposable items are to be disinfected after each patient use, prior to removal from treatment area/station and if contaminated between uses...Stethoscopes will be disinfected with alcohol prep pad and/or 1:100 (one to one hundred) bleach solution....” Observation on 03/06/2024 revealed RN #6 use his/her stethoscope to assess the patient at station #11. RN #6 hung the stethoscope off of his/her left wrist while documenting the assessment in the chairside electronic medical record (EMR) then left the station to assess the patient at station #10 without cleaning and disinfecting the stethoscope. Employee #6 placed the dirty stethoscope on a countertop with clean dialysis supplies away from the dialysis station after leaving the station without cleaning or disinfecting the stethoscope. Additionally, RN #6 was observed picking up the dirty stethoscope to assess the patient at station #3, left the station, assessed the patient at the weight scale, then proceeded to assess patients at stations #5 and #9 without cleaning and disinfection of the stethoscope between patients and stations. Observation on 03/06/2024 revealed PCT #12 gather a stethoscope from a hanger on a wall to listen to a patient’s vascular access at station #8. PCT #12 returned the dirty stethoscope to the hanger without cleaning and disinfecting the stethoscope. Observation on 03/06/2024 revealed PCT #10 use a stethoscope to listen to a patient’s vascular access at station #2. PCT #10 used a small alcohol prep pad to clean only the ear pieces and diaphragm on the bell of the stethoscope. The stethoscope tubing and entire bell were not disinfected. Employee #1 confirmed 03/06/2024 that staff did not clean and disinfect stethoscopes as required by facility policy.”

“IC-ASEPTIC TECHNIQUES FOR IV MEDS CFR(s): 494.30(b)(2) [The facility must-] (2) Ensure that clinical staff demonstrate compliance with current aseptic techniques when dispensing and administering intravenous medications from vials and ampules; and This Standard is not met as evidenced by: 37489 Based on document review, observation, and interview, it was determined that the facility failed to ensure: 1. staff appropriately labeled multi-dose Tubersol medication vial when opened. Failure to label medication vials when opened with an appropriate expiration date prevents staff from knowing when to discard the vial which increases the risk a patient will receive a medication that is no longer stable, and that may be contaminated due to reduction of preservative efficacy as well as an increased exposure to pathogens from accessing a vial multiple times; and 2. staff discarded expired vaccines which has the potential risk that patients may receive an expired, ineffective, and/or contaminated vaccine. Findings include: 1. and 2. The facility policy titled “Medication Policy” requires: “...Medications containing a preservative must be discarded 28 days after opening or accessed (e.g., needle punctured), unless the manufacturer specifies a different (shorter or longer) date or as directed by the manufacturer...Each vial is labeled with the initials of the person opening the vial and the expiration date...Disposal of expired medications....are removed from the treatment and inventory areas and disposed of per state/local regulations....” 1. Observation on 03/06/2024 revealed an open, in use multidose vial of Tubersol purified protein derivative. The vial was not labeled with an open or discard date. Employee #1 confirmed on 03/06/2024 that the open vial of Tubersol was not labeled with an expiration date as required by facility policy. 2. Observation on 03/06/2024 revealed the following expired vaccines in the home therapies medication refrigerator. 1 box - 10 count single dose 0.5 ml vials Pneumovax 23 Pneumococcal Vaccine Polyvalent expired on January 31, 2024 1 - single dose prefilled syringe Prevnar 13 Pneumococcal 13-Valent Conjugate Vaccine expired on October 31, 2023 1 box - 10 count prefilled syringes Prevnar 20, Pneumococcal 20-Valent Conjugate Vaccine expired on February 29, 2024 Employee #1 confirmed on 03/06/2024 that staff did not remove and discard expired vaccines as required by policy.”

“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: 37489 Based on review of facility policy, medical records and interview, it was determined that the facility failed to ensure: 1. AMAs (against medical advice) forms were completed for treatment times not met for (3) of (3) incenter hemodialysis patients (Patients #1, 2, and 4) with early termination of treatment which has the potential risk of adverse events related to inadequate dialysis; and 2. there was a documented discharge summary within 30 days of the patient’s discharge for (2) of (3) patients (Patient #7 and 8), which poses the potential risk of lack of coordination and continuity of care. Findings include: The facility policy titled “Prescribed Treatment Time Not Met” requires: “...1. The Registered Nurse (RN) will verify that a patient signs the Early termination of Treatment Against Medical Advice form any time the patient requests to terminate their treatment earlier than the prescribed run time....4. A copy of the Early termination of Treatment Against Medical Advice form signed by the patient, if shortened voluntarily by the patient, will be kept in the patient’s health record....” Patient #1 Treatment records dated 02/06/2024 through 03/05/2024 revealed (3) of (10) treatments were terminated early. The medical record did not contain AMA documentation for (3) of the (3) early terminated treatments. Patient #2 Treatment records dated 02/05/2024 through 03/04/2024 revealed (7) of (11) treatments were terminated early. The medical record did not contain AMA documentation for (6) of the (7) early terminated treatments. Patient #4 Treatment records dated 01/23/2024 through 03/05/2024 revealed (4) of (13) treatments were terminated early. The medical record did not contain AMA documentation for (4) of the (4) early terminated treatments. Employees #1 and 2 confirmed on 12/18/2023 that AMA forms were not completed for the aforementioned patients as required by facility policy. 2. Medical records review conducted on 03/11/2024 revealed missing discharge summaries from the following charts. Patient #7 The patient was discharged from the facility on 01/29/2024. The medical record did not contain a signed discharge summary completed by the patient’s nephrologist signed within 30 days of the patient’s discharge. Patient #8 The patient was discharged from the facility on 10/16/2023. The medical record did not contain a signed discharge summary completed by the patient’s nephrologist signed within 30 days of the patient’s discharge. Employee #1 confirmed on 03/11/2024 that Patients #7 and 8’s medical records did not contain discharge summaries completed within 30 days of the patients’ discharge from the facility.”