Fresenius Medical Care Santa Ana Dialysis

“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: 50003 Based on interview and record review, the facility failed to ensure the dialysis prescriptions were followed for two of two sampled patients (Patients 1 and 2) as evidenced by: 1. Patient 1 was being dialyzed with BFR of 300 ml/min for treatment date of 4/9/25. 2. Patient 2 was being dialyzed with BFR of 405 ml/min for treatment date of 4/9/25. These failures had the potential to cause access complication, inadequate dialysis clearance, and negative health outcome. Findings: Review of facility’s P&P titled Pre-Treatment Safety Checks Procedure dated 2/6/23, showed the clinician initiating treatment must verify the prescribed set up matches the patient: - Patient’s identity per policy - Prescription: dialyzer, dialysate composition, dialysate flow rate, time, goal set, needle size, and temperature. - Special attention orders are followed 1. On 4/9/25, review of Patient 1’s medical record was initiated. Patient 1 was admitted to facility on 4/25/22 with End Stage Renal Disease. Further review of Patient 1’s dialysis prescription order dated 4/9/25, showed dialysis order with BFR of 400 ml/min. The treatment flowsheet dated 4/9/25, showed Patient 1’s dialysis treatment was initiated on 0533 hours and ended 0834 hours. At 0533 hours, PCT documentation showed the treatment initiated without problem, access visible, denies complaints, patient alert, treatment started, 300 BFR, ACF test. Further review of the treatment flowsheet showed Patient 1 completed the entire treatment with a BFR of 300 ml/min. 2. On 4/9/25, review of Patient 2’s medical record was initiated. Patient 2 was admitted to facility on 4/22/19 with End Stage Renal Disease. Further review of Patient 2’s dialysis prescription order dated 4/9/25, showed dialysis order with BFR of 400 ml/min. The treatment flowsheet dated 4/9/25, showed Patient 2’s dialysis treatment was initiated at 0445 hours and ended at 0815 hours. Further review of treatment flowsheet showed Patient 2 completed treatment with BFR of 405 ml/hr. On 4/9/25 at 1400 hours, an interview was conducted with RN 2. RN 2 confirmed that Patient 1 had an order for BFR of 400 ml/min. He further stated Patient 1 had an access flow test done at the beginning of treatment for about 30 minutes at a BFR of 300 ml/min. RN 2 verified that Patient 1 should have his BFR at prescribed rate of 400 ml/min after the completion of the access flow test. He further stated that dialyzing patient at a low BFR could result in poor dialysis clearance leading to complications including uremia and other health issues. On 4/9/25 at 1440 hours, the Clinical Manager acknowledged the findings.”

“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: 50003 Based on interview and record review, the facility failed to ensure the patient’s BPs were monitored for one of two sampled patients (Patient 2) as per the facility’s P&P. * The PCT did not notify the RN of Patient 2’s abnormal BP readings as per the facility’s P&P for the treatments on 4/4, 4/7, and 4/9/25. This failure had the potential to place the patients at risk for delays in receiving the immediate interventions and treatments necessary to ensure the patients’ safety. Findings: Review of the facility’s P&P titled Patient Assessment and Monitoring dated 5/1/23, showed the steps for monitoring patient during the treatment include the following: - Obtain blood pressure and pulse rate every 30 minutes or more as needed but not to exceed 45 minutes or per state regulations. - Recheck blood pressures after a drop that requires interventions such as administering normal saline and reposition electronic cuff or use a manual cuff for aberrant blood pressure readings. - Report to the nurse of the SBP greater than 180 mmHg, DBP greater than 100 mmHg, or SBP less than or equal to 100 mmHg. On 4/9/25, review of Patient 2’s medical record was initiated. Review of the treatment flowsheets showed the following: * The treatment flowsheet dated 4/4/25, showed Patient 2’s dialysis treatment was initiated at 0440 hours and ended at 0812 hours. Patient 2’s BP was 164/88 mmHg at 0440 hours and dropped to 130/69 mmHg at 0502 hours (a drop of 34 mmHg for the SBP). However, there was no documented evidence the PCT had informed the RN of the decreased BP readings. * The treatment flowsheet dated 4/7/25, showed Patient 2’s dialysis treatment was initiated at 0505 hours and ended at 0840 hours. Patient 2’s BP was 172/94 mmHg at 0505 hours and dropped to 139/81 mmHg at 0536 hours (a drop of 33 mmHg for the SBP). At 0833 hours, Patient 2’s BP was 101/52 mmHg and dropped to 92/54 mmHg at 0836 hours (a drop below 100 mmHg for the SBP). However, there was no documented evidence the PCT had informed the RN of the decreased BP readings. * The treatment flowsheet dated 4/9/25, showed Patient 2’s dialysis treatment was initiated at 0445 hours and ended at 0815 hours. Patient 2’s BP was 164/83 mmHg at 0445 hours and dropped to 127/71 mmHg at 0505 hours (a drop of 37 mmHg for the SBP). However, there was no documented evidence the PCT had informed the RN of the decreased BP readings. On 4/9/25 at 1400, an interview and concurrent review of Patient 2’s medical records was conducted with RN 2. RN 2 verified the findings. RN 2 stated the PCTs were expected to notify the RN for any increase or decrease in the BP of greater than 20 mmHg compared to the previous BP reading during treatment for further assessment. On 4/9/25 at 1440 hours, an interview and concurrent record review was conducted with the Clinical Manager. The Clinical Manager acknowledged the findings.”