Fmc - Sanford

“POC-MANAGE VOLUME STATUS CFR(s): 494.90(a)(1) The plan of care must address, but not be limited to, the following: (1) Dose of dialysis. The interdisciplinary team must provide the necessary care and services to manage the patient’s volume status; This Standard is not met as evidenced by: 13252 Based on record review that facility failed to ensure fluid removal did not exceed 13 milliters (ml) per kilograms (kg) of body weight per hour (h) for treatments less than or equal to four hours for 1 of 5 patients (#4). Finding: Patient #4 admitted to the facility on 8/14/24 and the patient’s diagnoses included End Stage Renal Disease and Endocarditis. The physician orders dated 9/8/25 noted a treatment time of 3 hours and 45 minutes. Review of the patient’s treatments from 8/8/25 to 9/8/25 revealed that the staff removed more than 13 ml of fluid, from the patient on 4 of 9 treatments. On 8/8/25 Patient #4’s pre dialysis weight was 84.4 kg. The post treatment weight was 79.3 kg and the patient was treated fro 3 hours and 47 minutes. This means 5.5 kg of fluid was removed from the patient. The Ultrafiltratin reate is caculated using the total fluid removed in ml divided by (post dialysis weight multiplied by the time (hours). Therefore 5.5 kg is approximatley 5,500 ml divided by (80.4 kg x 3.77 h) is 18.14 ml/kg-h removed in a treatment time of less than 4 hours. On 8/27/25 Patinet #4 came the facility weighting 84.8 kg. The post treatment weight was 80.4 kg and the patient treated for 3 hiours & 17 minutes. This means removed fluid at rate of 15.21 ml/kg-h. On 8/28/25 Patinet #4’s pre-treament weight was 83.7 Kg. The patient was treated for 3 hours and 4 minutes and weighed 79.7, which meass 4 kg of fluid weight was rmoved. Therefore fluid was removed at rate of 16.5 ml/kg-h. On 9/8/25 the patient pre-treatment weight was 84.3 kg. The post treatment weight was 80.9 kg and the total treatment time was 2 hours and 57 minutes. Staff removed 3.4 kg of fluid at a rate of 14 ml/kg-h. The facilty staff needed to remove fluid at a rate of 13 ml/kg-h or less. Rapid or excessive fluid removeal during dialysis can cause mycardial stunning, an acute cardiac event, which may increase the risk of progressive heart damage over time.”

“POC-ACHIEVE ADEQUATE CLEARANCE CFR(s): 494.90(a)(1) Achieve and sustain the prescribed dose of dialysis to meet a hemodialysis Kt/V of at least 1.2 and a peritoneal dialysis weekly Kt/V of at least 1.7 or meet an alternative equivalent professionally-accepted clinical practice standard for adequacy of dialysis. This Standard is not met as evidenced by: 13252 Based on record review and interview the facility failed to follow the physician treatment orders for Blood Flow Rate (BFR) to achieve and sustain the prescribed dose of dialysis for 1 of 5 sampled patients (#2). Finding: Patient #2 admitted to the facilty on 6/11/25 and the patient’s diagnosis included Diabetes and Chronic Kidney disease. Review of the physician’s orders dated 8/25/25 note the patient was to be treated with a BFR of 400 milliliters per minute (ml/min). Review of 9 treatment records from 8/20/25 to 9/8/25 revealed staff did not follow the physician’s orders on 9/5/25. On 9/5/25 the patient had the pre-treatment evaluation at approximately 12:51 PM and started dialysis treatment shortly thereafter. The treatment run sheets noted the BFR was at 350 ml/min at approximately 1:19 PM. The 350 ml/min BFR was noted again at 1:31 PM, 2:01 PM, 2:38 PM, 2:57 PM, 3:06 PM and 3:33 PM. The staff failed to document the reason why a lower BFR was used to treat resident #2. On 9/11/25 at 2:15 PM the Clinical Manger reviewed the patient’s treatment on 9/5/25. She could not provide a reason as to why the physician prescribed BFR was not implemented.”