Davita Quincy Dialysis

“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: 51235 Based on observations, staff interviews and facility policy review, the facility failed to ensure that staff removed gloves between each station, and failed to ensure hand hygiene was performed after removing gloves for 3 of 12 observations. The findings include: On 10/21/2024 at approximately 10:40 AM. PCT (Patient Care Technician) C was observed wearing gloves prepping station #10, remove her gloves, donned new gloves and proceed to station #11 touching machine to silence an alarm. She returned to station #10, removed gloves and donned gloves without washing or performing hand hygiene. PCT C then began touching bloodlines and machine. On 10/21/2024 at approximately 10:50 AM RN (Registered Nurse) B observed cannulating (inserting fistula needles) fistula for initiation of dialysis for patient #13. RN B performed hand hygiene, donned a pair of gloves, evaluated access by palpating the site to locate the cannulation site and then proceeded to apply antiseptic, and insert the dialysis cannulation needles without changing gloves after touching the cannulation site. On 10/21/2024 at approximately 3:45 PM. PCT D was observed wearing gloves prepping station #18 proceed to station #16, touch machine with same gloves to silence the alarm. He then returned to station #18 touching machine with same gloves. At no point did PCT D remove his gloves and wash or sanitize his hands. An interview with PCT C on 10/21/2024 at approximately 2:00 PM confirmed that she should have performed hand hygiene before donning new gloves and before moving to another station. An interview with PCT D on 10/23/2024 at approximately 8:30 AM confirmed he should have removed gloves, performed hand hygiene and donned new gloves before moving to another station. An interview with RN B on 10/23/24 at approximately 9:30 AM confirms she did not disinfect access site after palpating the access after applying antiseptic. A review of the facility’s policy and procedure -1-05-01 entitled “Infection Control for Dialysis Facilities” Under heading HAND HYGIENE “1. All teammates, Physicians and Non-Physicians will perform hand hygiene - b. prior to gloving and immediately after removal of gloves; d. after patient and dialysis delivery system contact; g. before touching clean areas such as supplies, supply cart and chairside keyboard/mouse.” A review of the faciity’s policy and procedure entitled “AV (arteriovenous) Fistula or Graft Cannulation with JMS SYSLOC Mini Safety Fistula Needles (SFN) and Administration of Heparin Loading Dose,” #1-04-01D indicates “16. Remove gloves, perform hand hygiene an dput on clea gloves prior to cannulation.””

“IC-ASEPTIC TECHNIQUES FOR IV MEDS CFR(s): 494.30(b)(2) [The facility must-] (2) Ensure that clinical staff demonstrate compliance with current aseptic techniques when dispensing and administering intravenous medications from vials and ampules; and This Standard is not met as evidenced by: 51235 Based on observation, interview and review of the facility’s policy, the facility failed to ensure safe injection practices based on CDC (Center for Disease Control) guidelines were followed for 1 of 2 medication administrations observed. (Registered Nurse - RN A) The findings include: On 10/21/2024 at approximately 10:55 AM RN A was observed for medication preparation and administration. RN A was to administer Heparin 2000 units. RN A was observed to clean the vial stopper with an alcohol prep and withdrew approximately one milliliter of heparin with syringe, recapped needle, and set syringe aside. RN A then opened a new Heparin vial, cleaned vial stopper with alcohol prep, and used same syringe she used on first vial and withdrew heparin from second vial. An interview with RN A on 10/21/2024 at approximately 2:00 PM confirmed that she should have used a new sterile syringe and needle to enter the second vial. Review of the faciity’s policy and procedure entitled “Medication Policy” 1-06-01, indicates that multi-dose vials used for IV (intravenous) administration must be entered each time with a new sterile syringe and needle due to Center for Disease Control (CDC) guidance that states residual amounts of medication from a multi-dose vial (either in vial or syringe) must never be pooled with medication from another syringe. A review of the CDC’s website, https://www.cdc.gov/injection-safety/hcp/clinical-safety/index.html , indicates “ Healthcare providers should always use a new needle and syringe when accessing the contents of a multi-dose vial. Reuse of needles or syringes can contaminate medicine with germs, which can spread to others.””

“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: 45951 Based on patient record reviews, staff interviews and review of the facility’s policy and procedure, the facility failed to ensure that patients reached their prescribed target weight for 1 of 8 patients reviewed (Patient #9). The findings included: A total of nine treatment records were reviewed from 10/02/2024 to 10/21/2024 for Patient #9. It was noted on these nine treatment records that Patient #9 was prescribed to reach a target weight of 87.5kg (kilograms) or 88kg. On 10/09/2024, Patient #9’s prescribed target weight was 87.5kg; however, the recorded post treatment weight was 89.1kg. On 10/16/2024, Patient #9’s prescribed target weight was 88kg; however, the recorded post treatment weight was 89.2kg. On 10/18/2024, Patient #9’s prescribed target weight was 88kg; however, the recorded post treatment weight was 89.8kg. There was no inidcation the patient’s post treatment weights were addressed. A review of Patient #9’s progress notes provided for review revealed one Nursing Note, 10/14/2024, which indicated the Clinical Coordinator had spoken with the physician and received an order to change Patient #9’s prescribed target weight to 88kg. The surveyor was unable to find further documentation from the nursing staff regarding physician notification of Patient #9 not meeting their prescribed target weight. An interview was conducted with the facility’s Clinical Coordinator on 10/23/2024 at 12:46 PM. She independently reviewed Patient #9’s chart and found no additional documentation in the progress notes or the computerized chairside documentation to explain the miss of target weights for Patient #9 or if the physician was notified of this concern aside from her note written on 10/14/2024. A review of the facility’s policy and procedure entitled “Pre-Intra-Post Treatment Data Collection, Monitoring, and Nursing Assessment,” Policy: 1-03-08, dated April 2024, revealed the following: 12. The licensed nurse notifies the physician as needed if changes in patient status. 13. All findings, interventions, and patient response will be documented in the patient’s medical record.” On page 5, “Abnormal Findings” - “the teammate who is observing or collecting information should report to the licensed nurse whenever there is a concern for the patient’s condition. Members of the patient care team should report any changes in patient conditions or concerns of patient well-being immediately to the licensed nurse at any time.” Post-treatment if patient is above or below 1 kilogram (kg) from the target weight.”

“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: 45951 Based on patient record reviews, staff interviews and review of the facility’s policy and procedure, the facility failed to ensure the physician’s prescribed blood flow rate (BFR) and dialysate flow rate (DFR) were followed for 2 of 8 patients reviewed (Patient #1 and #3). The findings included: A total of seven treatment records were reviewed from 09/30/2024 to 10/21/2024 for Patient #1. It was noted on these seven treatment records that Patient #1 was prescribed to reach a blood flow rate (BFR) of 400 milliliters per minute (mL/min) and a dialysate flow rate (DFR) of 800mL/min. On 09/3020/24, the staff documented the DFR was set to 600 to 610mL/min for the whole treatment time. On 10/04/24, the staff documented the DFR was set to 600 to 610mL/min for the whole treatment time. On 10/14/24, the staff documented the BFR was set to 200 to 350mL/min for the whole treatment time. There was no indication why the prescribed rates were not followed. A total of nine treatment records were reviewed from 10/02/2024 to 10/21/2024 for Patient #3. It was noted on these nine treatment records that Patient #3 was prescribed to reach a blood flow rate (BFR) of 400 milliliters per minute (mL/min). On 10/09/2024, the staff documented the BFR was set to 250 to 300mL/min for most of the treatment time. On 10/14/2024, the staff documented the BFR was set to 200 to 350mL/min for most of the treatment time. There was no indication why the prescribed rate was not followed. An interview was conducted with the facility’s Clinical Coordinator on 10/23/2024 at 12:13 PM. She independently reviewed Patient #1 and Patient #3’s charts and found no documentation in the progress notes or the computerized chairside documentation to explain the consistent miss of prescribed BFR and DFR for Patients #1 and #3 or if the staff had notified the physician of these concerns. A review of the facility policy and procedure entitled “Pre-Intra-Post Treatment Data Collection, Monitoring, and Nursing Assessment,” 1-03-08, last revised April 2024 revealed the following: “10. If the dialysis prescription is not being met (including dialysis flow rate or change/inability to obtain prescribed flow rate) the reason will be documented, and the licensed nurse informed.” “12. The licensed nurse notifies the physician as needed if changes in patient status. 13. All findings, interventions, and patient response will be documented in the patient’s medical record.””