Fkc Millsboro

“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: 17991 Based on observation, interview, and policy review, the facility failed to ensure 1. one of two staff (Certified Clinical Hemodialysis Technician (CCHT) 2) failed to remove gloves, sanitize hands and don clean gloves after removing the CVC dressing (central venous catheter- a dialysis catheter that goes directly into the heart) and before applying antiseptic to the insertion site; 2. three patients (Patient (P)5, P8, P10) removed gloves and sanitized hands after holding needle access sites and before leaving the treatment floor; and 3. two of two patients (P5, P10) washed and/or sanitized their hands upon entering the dialysis treatment floor. These failed infection control practices place all 56 incenter patients, staff, and community at risk for transmission of blood borne pathogens and/or other microorganisms. Findings include: 1. Observation on 11/29/23 at 11:55 AM revealed CCHT 1 removed the CVC dressing for a patient sitting in station D. CCHT 1 failed to remove gloves, sanitize hands, and put on clean gloves before cleansing the area with antiseptic. During an interview on 11:30 AM at 12:15 PM, CCHT1 confirmed he/she did not remove gloves, sanitize hands, or apply clean gloves before cleaning the CVC insertion site. 2. Observation on 11/29/23 at 10:35 AM revealed P9 holding the access site with a gloved hand. P9 removed the glove after hemostasis (site stopped bleeding). Staff failed to offer the patient hand sanitizer or instruct him/her to wash hands before leaving the treatment floor. P9 gathered up personal items, touched the scales to obtain his/her weight then proceeded to leave the dialysis treatment floor. Observation on 11/29/23 at 2:50 PM revealed P5 holding the access site with a gloved hand. P5 removed the glove after hemostasis. Staff failed to offer the patient hand sanitizer or instruct him/her to wash hands before leaving the treatment floor. P5 gathered up personal items, touched the scales to obtain his/her weight then proceeded to leave the dialysis treatment floor. Observation on 11/29/23 at 3:35 PM revealed P10 holding the access site with a gloved hand. P10’s access site began bleeding and leaking around the dressing. Staff assisted P10 with reinforcing the dressing to stop the bleeding. P10 was observed answering his/her phone with the gloved hand. P10 removed the glove after hemostasis. Staff failed to offer the patient hand sanitizer to disinfect his hand and phone and failed to instruct him/her to wash hands before leaving the treatment floor. P10 gathered up personal items, touched the scales to obtain his/her weight then proceeded to leave the dialysis treatment floor. 3. Observation on 11/29/23 at 10:05 AM revealed P5 entered the dialysis treatment floor, walked past the sink, weighed at the scales, then proceeded to the dialysis station. P5 failed to wash hands and staff failed to offer him/her hand sanitizer. Observation on 11/29/23 at 10:53 AM revealed P10 entered the dialysis treatment floor, walked past the sink, weighed at the scales, then proceeded to the dialysis station. P10 failed to wash hands and staff failed to offer him/her hand sanitizer. During an interview on 11/29/23 at 3:45 PM, Patient Care Technician.(PCT) 1 confirmed she did not offer P10 hand sanitizer for his/her hands or phone and failed to encourage him/her to wash hands before leaving the treatment floor. During an interview on 11/29/23 at 3:45 PM, Registered Nurse (RN)1 confirmed patients should wash their hands after holding the access site or use hand sanitizer. Review of a policy entitled, “Central Venous Catheter Dressing Change,” dated 11/02/2019, indicated “Follow the steps below to remove a catheter dressing and inspect the exit site before the initiation of treatment...7 Discard dressing and remove gloves. Perform hand hygiene.” Review of a policy entitled “Hand Hygiene,” dated 11/06/2023, indicated ...”All staff, patients ...must follow the same requirement for hand hygiene ...The table below identifies when hands shall be washed specifically with soap and water or when alcohol-based hand rubs can be used ...Entering and leaving the treatment area ...Hand Hygiene Patient ...Gloves must be provided to patients when performing procedures which risk exposure to blood or body fluids, such as when ...holding access sites post treatment to achieve hemostasis. To help ensure the prevention of cross contamination to their family members or other patients, hand hygiene must be performed.””

“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: 17991 Based on record review, interview, observation, and policy review, the facility 1. failed to follow the physician ordered dialysis prescription (an artificial means of kidney function that removes the waste and excess fluid from the blood by passing through a filter) for six (Patient (P)8, P1, P4, P5, P6, and P7) of eight patient records reviewed; 2. staff failed to provide documentation and/or rationale for adjusting the prescription; and 3. licensed staff failed to consistently document verification of the dialysis prescription. Failure to follow the physician ordered dialysis prescription had the potential to negatively impact the effectiveness of dialysis for all 56 in-center dialysis patients. Findings include: 1. Review of a “Physician Order,” given by the facility, dated 09/28/23, indicated P8 was to have a 2K dialysate (the fluid used in dialysis to remove impurities from the patients’ blood) and a DFR (dialysate flow rate) of 700 mL/min. (milliliters per minute). Observation on 11/30/23 at 2:15 PM, P8 was receiving a 3K dialysate and a DFR of 500 mL/min. During an interview on 11/30/23 at 2:15 PM, Certified Clinical Hemodialysis Technician (CCHT) 2 confirmed P8’s dialysis prescription was not being followed. CCHT 2 immediately corrected the dialysate and DFR. During an interview on 11/30/23 at 2:45 PM, Registered Nurse (RN) 2 said he/she verified the prescription but must have “missed” the incorrect dialysate and DFR. Review of the “Treatment Sheet,” dated 11/30/23 and provided by the facility, indicated P8’s treatment was initiated at 12:38 PM. Further review revealed an RN failed to document verification of the prescription. 2. Review of a “Physician Order,” dated 11/06/23 and provided by the facility, indicated P1 was to have a BFR (blood flow rate) of 400 mL/min. and a DFR of 800 mL/min. Review of the “Treatment Sheet,” provided by the facility and dated 11/16/23, indicated P1’s treatment was initiated at 7:12 AM and terminated at 10:32 AM. The BFR ran at 450 mL/min. and the DFR ran at 500 mL/min. the entire treatment with no documented rationale. RN 2 verified the dialysis orders on 11/16/23 at 7:12 AM. Review of the “Treatment Sheet,” provided by the facility and dated 11/23/23, indicated P1’s treatment was initiated at 6:10 AM and terminated at 9:14 AM. The DFR ran at 500 mL/min. the entire treatment. Staff failed to document why the DFR was adjusted. Further review revealed an RN failed to document the prescription had been verified. Review of the “Treatment Sheet,” provided by the facility and dated 11/25/23, indicated P1’s treatment was initiated at 6:18 AM and terminated at 9:55 AM. The DFR ran at 500 mL/min. the entire treatment. Staff failed to document why the DFR was adjusted. Further review revealed an RN failed to document the prescription had been verified. 3. Review of a “Physician Order,” dated 10/16/23 and provided by the facility, indicated P4 was to have a BFR (blood flow rate) of 375 mL/min. Review of the “Treatment Sheet,” provided by the facility and dated 11/15/23, indicated P4’s treatment was initiated at 12:02 PM and terminated at 3:35 PM. The BFR was set at 375 mL/ min. at 12:01 PM but was adjusted to 300 mL/min. at 12:31 PM and remained there until the treatment was terminated. The staff failed to document why the BFR was decreased. 4. Review of a “Physician Order,” dated 11/11/23 and provided by the facility, indicated P5 was to have a BFR (blood flow rate) of 475 mL/min. and a DFR rate of 700 mL/min. Review of the “Treatment Sheet,” provided by the facility and dated 11/24/23, indicated P5’s treatment was initiated at 10:02 AM and terminated at 2:19 PM. RN 1 documented the prescription had been verified on 11/24/23 at 9:58 AM. The DFR ran at 500 mL/min. the entire treatment. Staff failed to document why the DFR was adjusted. Review of the “Treatment Sheet,” provided by the facility and dated 11/27/23, indicated P5’s treatment was initiated at 10:14 AM and terminated at 2:20 PM. The RN failed to document the prescription had been verified. The BFR ran at 450mL/min. from 10:18 AM until 1:03 PM when the BFR was decreased to 400 mL/min. The BFR remained at 400 mL/min. until the treatment was terminated. Staff failed to document why the BFR was adjusted. 5. Review of a “Physician Order,” dated 11/13/23 and provided by the facility, indicated P6 was to have a DFR rate of 700 mL/min. Review of the “Treatment Sheet,” provided by the facility and dated 11/15/23, indicated P6’s treatment was initiated at 3:31 PM and terminated at 7:05 PM. Further review revealed an RN failed to document the prescription had been verified. The DFR ran at 500 mL/min. for the entire treatment. Staff failed to document why the DFR was adjusted. Review of the “Treatment Sheet,” provided by the facility and dated 11/17/23, indicated P6’s treatment was initiated at 4:05 PM and terminated at 7:55 PM. Further review revealed an RN failed to document the prescription had been verified. The DFR ran at 500 mL/min. for the entire treatment. Staff failed to document why the DFR was adjusted. Review of the “Treatment Sheet,” provided by the facility and dated 11/20/23, indicated P6’s treatment was initiated at 3:56 PM and terminated at 7:53 PM. Further review revealed an RN failed to document the prescription had been verified. The DFR ran at 500 mL/min. for the entire treatment. Staff failed to document why the DFR was adjusted. Review of the “Treatment Sheet,” provided by the facility and dated 11/27/23, indicated P6’s treatment was initiated at 3:30 PM and terminated at 7:30 PM. Further review revealed an RN failed to document the prescription had been verified. The DFR ran at 500 mL/min. for the entire treatment. Staff failed to document why the DFR was adjusted. 6. Review of a “Physician Order,” dated 11/13/23 and provided by the facility, indicated P7 was to have a BFR (blood flow rate) of 450 mL/min. and a DFR rate of 500 mL/min. Review of the “Treatment Sheet,” provided by the facility and dated 11/24/23, indicated P7’s treatment was initiated at 11:51 AM and terminated at 2:26 PM. RN 1 verified the dialysis prescription at 10:59 AM. The BFR ran at 400 mL/min. for the entire treatment. Staff failed to document why the BFR was adjusted. During an interview and record review with the Clinical Manager on 11/20/23 at 3:30 PM and on 12/01/23 at 4:00 PM she confirmed the staff had not followed the physician ordered dialysis prescription for P1, P4, P5, P6, P7, and P8. She/he also confirmed if there was a clinical reason for adjustment to the prescription, it should have been documented. Review of a policy entitled “Patient Assessment and Monitoring,” dated 05/01/2023, indicated... “The purpose of this policy is to provide guidance to FKC (Fresenius Kidney Care) direct patient care staff on assessment and monitoring patients before, during and after treatment ...Follow the steps below for monitoring patient and machine parameters during treatment... Check machine setting and measurement: Check prescribed blood flow is being achieved or reason is documented in medical record if unable to meet prescribed blood flow. Check dialysate flow rate setting is correct, and the prescribed flow is being delivered.” Review of a policy entitled “Nursing Supervision and Delegation,” dated 11/06/2023, indicated ...The registered nurse must evaluate each patient preferable within an hour ...to: Review patient treatment prescription and equipment parameters to verify correct setting, and if dialysis prescription is being followed.””