Davita Florin Dialysis Center

“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: 45718 Based on interview and record review, the facility failed to ensure the Hemodialysis prescription ( Hemodialysis, a medical procedure that helps remove waste and excess fluid from the blood when the kidneys are unable to perform this function; hemodialysis prescription is a set of instructions that outlines the parameters for a hemodialysis treatment session) was followed for 1 of 3 sampled patients (Patient 1) when the hemodialysis staff increased Patient 1’s dialysate temperature (dialysate temperature is the temperature of the solution that is used to clean the blood during dialysis). This failure increased the potential for Resident 1 to develop Hemodialysis complications. Findings: A review of Patient 1’s “Treatment Details Report” dated 9/12/23, indicated, “DIALYSIS PRESCRIPTION ...Dialysate Temperature 36.0°C ...” A review of Patient 1’s “Patient note” dated, 9/21/23, indicated, “An hour after treatment started [sic] patient started to shake and shiver ...BP [Blood Pressure] was 159/67 ...Temp [Temperature] was 98.2 ...dialysate temperature was increased to 37 degrees Celsius ...40 minutes later patient vomits, and BP increased to 192/99 temp increased to 98.7 ...” During a telephone interview on 9/3/23 at 1:37 p.m., with the Licensed Nurse (LN1), the LN 1 confirmed she increased Patient 1’s dialysate temperature to 37°C without a physician’s order during his treatment on 9/21/23. She stated, she was not sure if there is a protocol that they can adjust the dialysate temperature without a physician’s order. She further stated, if the patient’s blood pressure is low and the patient is symptomatic then they can raise the dialysate temperature. During a telephone interview on 9/3/23 at 2:47 p.m., with the Clinical Coordinator (CC), the CC stated, the facility does not have a standing order or a protocol to adjust the dialysate temperature without a physician’s order. She further stated, they need to inform the physician to order a change in the dialysate temperature every time they increase or decrease the dialysate temperature. She further stated her expectations is to follow the dialysis prescription and the staff need to have a physician’s order before changing the prescription like the dialysate temperature. A review of facility policy titled, “PRE-INTRA-POST TREATMENT DATA COLLECTION, MONITORING AND NURSING ASSESSMENT, revised October 2023, indicated, “ ...11. Abnormal findings or findings outside of any patient specific physician ordered parameters will be reported to the licensed nurse immediately ...The licensed nurse will use ... clinical judgement ...if any clinical interventions are necessary ...The licensed nurse notifies the physician ...of changes in patient status ...” A review of American Journal of Kidney Disease (AJKD), National Kidney Foundation article titled, “Body temperature regulation during hemodialysis in long-term patients: is it time to change dialysate temperature prescription?” dated, July 2004, indicated, “During hemodialysis procedures, changes in the dialysate temperature can raise or lower body temperature because the blood is returned to the patient ...with the dialysate. Even a dialysate temperature equal to the patient’s body temperature ...can result in an increase in the patient’s body temperature, leading to cutaneous vasodilation and the potential for cardiovascular instability ...” https://www.ajkd.org/article/S0272-6386%2804%2900519-0/pdf”