Davita Orlando East 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: 51504 Based on observation and interview, the facility staff failed to encourage patients to perform hand hygiene prior to and post treatment as per Centers for Disease Control (CDC) guidelines for handwashing. Finding: On July 29, 2025, during the survey, Patients #9, #10, #19, and #204 were observed leaving the treatment floor without washing their hands. On July 29, 2025 during the survey, Patients #12, #21, #22, and #23 were observed coming into treatment without performing hand hygiene. During an interview on July 29, 2025, at 11:15 AM, Staff A was asked about patient handwashing before and after treatment and if staff members encouraged handwashing. She stated, “I personally don’t suggest for patients to wash their hands.” During an interview on July 29, 2025, at 11:31 AM, the Administrator stated, “staff are expected to suggest handwashing before and after (treatment).” Review of the policy titled, “Infection Control for Dialysis Facilities,” revised April 2023, read: “HAND HYGIENE 2. Patients and caregivers will be encouraged to a. Wash their hands and access extremity upon entering the treatment area prior to the initiation of dialysis. b. Perform hand hygiene after treatment before leaving the treatment area.””

“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: 51504 Based on record review and interview, the facility failed to show evidence of reporting a change in status in blood pressure (BP) to a Registered Nurse (RN) for 2 of 8 sampled patients, (#4, #5). Findings include: Review of Patient #4’s clinical record showed he received In-Center Hemodialysis (ICHD) 3 times per week for 210 minutes with a dialysis order for 2K (potassium)/ 2.5 Ca (Calcium)/ Acid, Dry Citrate to be utilized through a Optiflux F180NR dialyzer. Review of Patient #4’s intradialytic flow sheets showed on 7/7/25 at 11:24 AM, his blood pressure (BP) was 165/108 millimeters of mercury, and at 11:54 AM, BP was 162/101, on 7/9 at 11:48 AM, BP was 154/120, at 1:48 PM, BP was 160/100, and at 2:49 BP was 148/101. On on 7/11 at 12:22 PM, BP was 152/102, at 12:52 PM, BP was 159/112, and at 3:06 PM, BP was 119/107. On 7/16 at 11:36 AM, BP was 150/101, at 12:06 PM, BP was 145/103, and at 12:37 PM BP was 161/105. On 7/21 at 10:53 AM, BP was 149/101, at 11:05 AM, BP was 152/103, at 11:20 AM, BP was 156/103, and at 11:50 AM BP was 150 100. On 7/28 at 12:04 PM, the patient’s BP was 164/112, at 12:34 PM, BP was 176/116, at 1:04 PM, BP was 168/117, at 1:35 PM, BP was 161/109, at 2:07 PM, BP was 169/110 and at 2:37 PM, BP was 169/109. Review of patient #4’s flow sheets did not reveal a progress note or notification to the nurse on duty on the above listed times of the changes in blood pressures. Review of Patient #5’s clinical record showed she received an In-Center Hemodialysis (ICHD) with an order for treatment 3 times per week for 210 minutes with dialysis order for 2 K/ 2.5 Ca/ Acid, Dry Citrate to be utilized through a Optiflux F180NR dialyzer. Review of Patient #5’s interdialytic flow sheets showed on 7/19/25 at 4:43 PM, BP was 158/104 and at 5:12 PM, BP was 168/108. Further review revealed no progress note from or notification to the nurse of the change in BP. During an interview conducted on 7/31/25 at 3:45 PM, the Facility Administrator confirmed the days and BP readings and stated, “They should have notified the nurse each of those times and documented it on the flow sheets.” The facility policy with review date of June 2025 titled, “ Pre-Intra-Post Treatment Data Collection, monitoring and nursing assessment,” noted, “Abnormal Findings ...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 ...Blood pressure-Intradialytic: systolic greater than 180 mm/hg or less than 90 mm/hg, diastolic greater than or equal to 100 mm/Hg or less than 50 mm/hg.””