Fmc New Haven Home Dialysis

“H-FAC RECEIVE/REVIEW PT RECORDS Q 2 MONTHS CFR(s): 494.100(b)(2),(3) The dialysis facility must - (2) Retrieve and review complete self-monitoring data and other information from self-care patients or their designated caregiver(s) at least every 2 months; and (3) Maintain this information in the patient ’ s medical record. This Standard is not met as evidenced by: 44675 Based on clinical records, facility policy and interviews for one (1) of eight (8) patients (Patient #5), reviewed for treatments, the facility failed to educate patients when fluid guidelines were not being followed in accordance with physician’s orders, for two (2) of eight (8) patients (Patient #5 and #7) reviewed for treatments, the facility failed to educate patients regarding proper treatment documentation, and for one (1) of four (4) patients (Patient #8), reviewed for treatment flowsheets, the facility failed to ensure the patient documented treatments and vital signs and re-educated when not completed. The findings included: 1. Patient #5 had diagnoses that included End Stage Renal Disease (ESRD), a physician’s order for daily Peritoneal Dialysis (PD) of six (6) exchanges of 2700 milliliters of varied dialysate strengths (1.5%, 2.5%, and 4.25%) with a last fill of 1890 milliliters of icodextrin (a glucose solution) instilled using a PD catheter. A physician’s note dated 6/24/25 identified Patient #5 was actively trying to reduce his/her weight, there was no swelling/edema noted, and to maintain the current order of three (3) 2.5% dialysate solution and one (1) icodextrin solution with treatments. Review of Patient #5’s July 2025 treatment sheets identified Patient #5 had modified his/her dialysate solution use with treatments on 7/3/25, 7/6/25, 7/8/25, 7/9/25, 7/11/25, 7/13/25, 7/14/25, and 7/16/25 and used 1.5%, 2.5% dialysate solution and icodextrin with treatments. Review of July 2025 clinic and nursing notes failed to identify Patient #5’s prescription had changed or that the nurse addressed the modification in Patient #5’s solution use for the treatments listed above. Interview with the Clinic Manager on 9/24/25 at 10:12 AM identified nursing staff are expected to document that patient education was provided when fluid guidelines/physician’s orders were not followed. The Clinic Manager further identified the facility practice was for nurses to check the patient’s treatment records at least monthly to ensure adherence to physician’s orders and to document any discrepancy/concern related to orders not being followed. Review of the Review and Documentation of Home Therapies Patient Health Data policy directed treatment data would be reviewed by the home therapies nurse in order to identify trends, determine if patients are following their treatment plans or having problems with their dialysis at home. The policy further directed the home therapies nurse would perform a monthly review of all treatment data, regardless of the method of data submission. 2. Patient #5 had diagnoses that included ESRD, a physician’s order for daily PD of six (6) exchanges of 2700 milliliters of varied dialysate strengths (1.5%, 2.5%, and 4.25%) and a last fill of 1890 milliliters of icodextrin administered through a PD catheter. a) Review of Patient #5’s August 2025 treatment records identified missing blood pressure entries on 8/24/25, 8/28/25, 8/29/25, and 8/31/25. Review of nursing notes dated 8/29/25 through 9/22/25 failed to identify Patient #5 received education regarding blood pressure documentation. b) Patient #7 had diagnoses that included end stage renal disease, a physician’s order for daily PD of three (3) exchanges of 2000 milliliters of varied dialysate strengths (1.5%, 2.5%, and 4.25%) administered through a PD catheter. Review of Patient #7’s July 2025 and August 2025 treatment sheets identified missing blood pressure entries on 7/3/25, 7/4/25, 7/12/25, 7/15/25, 7/17/25, 7/24/25, 7/30/25, 8/2/25, 8/4/25, and 8/6/25. Review of July 2025 and August 2025 nursing notes failed to identify documentation issues or that education was provided regarding the missing entries in Patient #7’s treatment records. Interview with the Nurse Manager on 9/24/25 at 11:55 AM identified facility practice was to document when patients received education regarding treatment record documentation and that, although the nurse probably educated the patient regarding the missing blood pressure entries, he/she failed to document the education occurred in the patient’s medical record. Review of the Review and Documentation of Home Therapies Patient Health Data policy directed the patient to create a treatment record for every dialysis treatment according to policy and regulatory requirements. 3. Patient #8 was admitted to the clinic with diagnoses that included ESRD. Review of the physician’s orders directed Continuous Cycling Peritoneal Dialysis (CCPD) seven (7) days a week, five (5) exchanges, cycle time of ten (10) hours and fifty-five (55) minutes, target weight of 74 kilograms (kg) and a right upper quadrant PD catheter. The stable care plan dated 12/2/24 identified Patient #8 had an area of focus for dialysis adequacy with interventions that included to educate Patient #8 on his/her treatment prescription. Patient #8 occasionally missed treatment, or discontinued treatment early. Patient #8 was educated on the importance of following treatment prescription. Patient #8 stated that when he/she missed treatments, he/she did manual exchanges and the physician was aware. A nursing note dated 3/17/15 identified Patient #8 was asked to monitor his/her weight and blood pressure to make sure they stay in good range. A nursing note dated 4/10/25 identified Patient #8 stated having trouble breathing, especially at night. Patient #8 had fluid on his/her lower extremities, including ankles. Patient #8 was notified to use all 2.5 % dextrose on cycler. However, the nursing note failed to address Patient #8’s missed treatments so far in April and lack of vital sign and weight monitoring at home for every treatment in April so far and if education had been provided. Review of Patient #8’s PD treatment sheets dated 4/1/25 - 4/29/25 identified there was no manual patient data completed (including weight, blood pressure, pulse, time on cycler and dextrose solution used) for twenty-three (23) out of twenty-three (23) opportunities. The flowsheet further identified Patient #8 had three (3) undocumented/not completed treatments. A hospital discharge summary dated 4/29/25 - 5/3/25 identified Patient #8 was admitted to the hospital with hypervolemia due to incomplete adherence to PD. Upon initial presentation, Patient #8 stated dyspnea with evidence of pulmonary congestion and elevation in troponins likely in the setting of fluid overload. Patient #8 was resumed on PD in the emergency room with an increase in concentrations to 2.5 % with intermittent manual exchanges on 4.25 %. Interview with the Clinical Manager on 9/24/25 at 1:00 PM identified in review of Patient #8’s treatment flowsheets for April 2025, Patient #8 did not enter in any required patient data (blood pressures, pulses, weights). Review of Patient #8’s nursing notes for April 2025 identified Patient #8’s lack of documentation and treatment adherence was not addressed. She identified the expectation is for treatment flowsheets to be reviewed at a minimum of monthly. If there are issues identified, the nurse should educate and document. She identified when Patient #8 misses treatments, he/she will do manual treatments throughout the next day. However, the patient is suppose to notify the nurse if he/she missed and document manual exchanges. Review of the home therapies patient treatment record keeping policy directed that a record is required for each treatment. Patients will be taught to complete a daily record of home dialysis treatments and educated regarding the importance of maintain the records completely and accurately. Patients who do not use electronic flowsheets or other connected health technologies will record treatment data on paper treatment flowsheets. Home treatment records will be reviewed by the home therapy registered nurse during patient monthly clinic visits to identify trends, errors or omissions and other issues or concerns to be addressed with the patient and/or care partner.”