032628 Kingman Dialysis Clinic (Fmc)

“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: 51929 Based on document review, observation, and interview, it was determined that the facility failed to ensure staff cleaned and disinfected their stethoscope between and after use on multiple patients and thoroughly disinfect the non-disposable blood pressure cuffs at each station which poses a potential risk of increased infection for patients through contact transmission and cross contamination of pathogenic organisms that may be harbored on the dirty stethoscope. Findings include: The facility policy titled “Cleaning and Disinfecting the Dialysis Station” requires: “...The Centers for Medicare and Medicaid Services (CMS) has regulations that in order to prevent cross contamination, a dialysis station must be cleaned and disinfected between dialysis patients. The chair and dialysis equipment are used by multiple patients during a treatment day and it is critical that these items be thoroughly cleaned and disinfected between used...Also, the nature of dialysis treatments with frequent exposure to blood and body fluids, close proximity of patients and staff, and the immunocompromised status of dialysis patients make dialysis a high-risk area for spreading infectious disease...Dialysis station...Area including the dialysis machine, chair/bed and other reusable equipment or supplies utilized during dialysis treatment...General Cleaning...After use, any non-disposable equipment and supplies brought into the dialysis station (ex. Stethoscope) must be disinfected with 1:100 bleach or EPA registered disinfectant before being removed from the dialysis station....” The facility policy titled “Access Assessment and Cannulation” requires: “...Assessment of Vascular Access...LISTEN...Bruit high pitch/whistle...Document in treatment record...Staff...who have been trained to auscultate vascular accesses should listen to the entire length of the access for changes in the sound of the bruit...Clean stethoscope after assessing a patient....” Observation on 02/25/2025 revealed Employee #6 conduct pre and post assessment of heart and lung sounds, cleansed the stethoscope, hung it around the neck and then proceeded with the same stethoscope to the next patient assessment at station #20 with out cleaning the stethoscope prior to patient care. Observation on 02/25/2025 revealed Employee #10 auscultate a fistula at station #28, cleanse the stethoscope, return the stethoscope to hanging around the neck, proceed to auscultate lungs for post assessment on a patient in station #25 without cleansing the stethoscope prior to patient care. Observation on 02/25/2025 at station #4 revealed a visibly dirty non-disposable blood pressure cuff. The patient sat in the chair and proceeded to pull hair from the worn velcro on the blood pressure cuff. Observation on 02/25/2025 at station #20 revealed a worn and tattered blood pressure cuff with several fibers stuck in the velcro. Employee #2 confirmed on 02/25/2025 that staff did not return the clean and disinfected stethoscope after use to the dialysis station and between multiple patients as required by facility policy. Additionally, staff are not able to thoroughly cleanse the velcro of the blood pressure cuffs.”

“PE-BUILDING-CONSTRUCT/MAINTAIN FOR SAFETY CFR(s): 494.60(a) The building in which dialysis services are furnished must be constructed and maintained to ensure the safety of the patients, the staff and the public. This Standard is not met as evidenced by: 49430 Based on document review, observation, and interview, it was determined that the facility failed to ensure medications were locked when not in use at the medication preparation station. Failure to secure medications when not in use may result in unauthorized access to medication not prescribed to an individual and the potential for tampering or other compromise to the integrity of medications administered. Findings include: The policy titled “Medication Preparation and Administration” requires: “...pre-drawn medications shall be labeled and must be kept under the preparer’s control or in a locked designated medication storage area or refrigerated, if necessary, until delivery to the appropriate patient for administration...All medications will be kept in a locked cabinet except when in use....” Observation on 02/21/2024 revealed one unlocked drawer at the handwash station located immediately inside the patient main entry door. No staff were present in the area and the medications were not in use. The drawer contained 2, 3 cc syringes, labeled heparin with a patient’s label affixed to both. No time or initials on the labels. Employee #7 confirmed on 02/21/2024 that the medications were not locked when not in use as required by facility policy.”

“PA-APPROPRIATENESS OF DIALYSIS RX CFR(s): 494.80(a)(2) The patient’s comprehensive assessment must include, but is not limited to, the following: (2) Evaluation of the appropriateness of the dialysis prescription, This Standard is not met as evidenced by: 49430 Based on document review and interview, it was determined that the facility failed to ensure that staff followed the attending physicians prescribed hemodialysis (HD) order for blood flow rate for patients #4, #5, and #6. Failure to follow physician orders poses the potential risk of inadequate dialysis, decreased clearances and hospitalizations. Findings include: The facility policy titled “Patient Assessment and Monitoring” requires: “...Check machine settings and measurements: Check prescribed blood flow is being achieved or reason is documented in the medical record if unable to meet prescribed blood flow....” Patient treatment sheet revealed; Patients #4, #5 and #6 had multiple occurrences when the Blood Flow Rate (BFR) was not set at the prescribed rate or the BFR was changed during treatment without any documentation of reason for the change. Employee #3 confirmed that services were not administered per facility policy.”

“PA-ASSESS B/P, FLUID MANAGEMENT NEEDS CFR(s): 494.80(a)(2) The patient’s comprehensive assessment must include, but is not limited to, the following: Blood pressure, and fluid management needs. This Standard is not met as evidenced by: 49430 Based on a review of facility policy, medical records, and staff interviews, it was determined that the facility failed to require clinical staff to notify the nurse and the nurse provide a documented intervention for 5 out of 6 patients reviewed when the patient’s blood pressure (BP) and/or heart rate (HR) was out of range per the facility policy, which poses the potential risk of cardiovascular compromise and hospitalization. Findings include: Facility policy titled, “...Patient Assessment and Monitoring....” published December 2022, revealed: “...Monitoring During Treatment...Report to the nurse: Systolic blood pressure greater than 180 mm/Hg, Diastolic blood pressure greater than 120 mm/Hg, Blood Pressure less than or equal to 90 mm/Hg systolic ... Any significant drop in Systolic blood pressure greater than 40mm/Hg ...Heart rates that have dropped below 60 or risen above 100 ...Report to the nurse any significant findings....” “...Treatment Sheets....” revealed: Patients #2, #3, #4, #5 and #6 all had multiple treatment sheets with BP and HR out of facility parameters that were not found to have any documentation of Patient Care Technician (PCT) reported to nurse or that the nurse assessed and/or treated out of rang BP and/or HR. Employee #3 confirmed, on 02/22/2024, that this practice was not following facility policy.”