Fmc - Ybor City

“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: 34768 Based on observation, interview, and record review the facility failed to ensure the staff followed infection control precautions for one of two sampled patients (#2) during observation of accessing the fistula for initiation of dialysis, during cleaning of a dialysis station and wearing of artificial fingernails. Findings included: During observation of dialysis treatment on 09/18/2024 at 10:30 a.m. it was noted that Staff A, Patient Care Technician (PCT) was accessing the AV fistula for Patient #2. Staff A removed her gloves and replaced her gloves without hand sanitizing. It was noted she had artificial fingernails longer than her fingers. Staff A pushed up the patient’s sleeve with gloves in place. Staff located and palpated for the thrill and listened for the bruit through a stethoscope. Staff A cleaned the stethoscope. She removed her gloves and replaced one glove on her right hand. Staff A opened a supply drawer and removed supplies. She replaced her second glove. Staff A cleansed the AV site with disinfectant. A tourniquet was applied. Staff A accessed both upper and lower sites and applied tape. Staff A removed her gloves, hand sanitized, and moved the patient’s wheelchair. Staff A supplied gloves, inputted into the dialysis machine, touched her face, touched the computer and removed her gloves. She touched her face, hand sanitized, and replaced her gloves. She inputted into the dialysis machine and attached the tubings to the cannulation needles. On 09/18/2024 at 9:23 a.m. Staff A, PCT was cleaning station 22 with only a right glove on. Staff A touched the used oxygen machine and used blood pressure cuff with her bare left hand. She cleaned the dialysis machine and chair with her gloved right hand. She held the used blood pressure cuff in her non -gloved hand and wiped it with the bleach cleaner with the gloved hand. She removed her right glove and hand sanitized. During an interview with the Facility Administrator / Director of Nursing on 09/19/2024 at 12:20 pm. stated the staff needed to remove their gloves, perform hand hygiene and re-glove. The staff was not to have artificial fingernails. The hand sanitizing was to be done after touching inanimate objects. He stated everything was dirty. Record review of the facility’s Policy, “Hand Hygiene,” published 11/06/2023 showed 07/05/2022 showed the purpose of the policy is to prevent transmission of pathogenic microorganisms to patients and staff through cross contamination. Hand hygiene includes either washing hands with soap and water or using a waterless alcohol based antiseptic hand rub with 60 to 90% alcohol content. Hands will be decontaminated using alcohol based hand rub or by washing hands with antimicrobial soap and water before and after direct contact with patients, before performing any invasive procedure such as vascular access cannulation or administration of parental medications, immediately after removing gloves after contact with body fluids or excretion, mucous membranes, non-intact skin, and wound dressings if hands are not visibly soiled after contact with inanimate objects near the patient when moving from a contaminated body site to a clean body site of the same patient after contact with other objects within the patient station or treatment space Record review of the facility’s policy, “Employee Dress Code,” effective 06/18/2021 showed fingernails must be clean and no more than ¼ of an inch beyond tip of the finger. 5. Fingernail polish or imitation fingernails are not allowed.””

“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: 44048 Based on interview, and record review the facility failed to implement the physician ordered dialysis prescription for two (Patient #1 and Patient #2) out of two sampled patients. This failure resulted in the potential for inadequate dialysis treatments for Patient #1 and Patient #2. Findings: 1. On 2/27/2022 Patient #1’s medical record was reviewed. Patient #1 was admitted to the end-stage renal dialysis clinic (ESRD) for in-center hemodialysis on 9/4/2020. a. The dialysis prescription order dated 1/17/2024 indicated: -Hemodialysis 3x qw (three times a week). -Dialyzer: Optiflux 200NRe -Blood flow rate (BFR): 550 -Dialysate flow rate (DFR): Manual 700 -Potassium: 2.0 -Sodium: 137 -Estimated Dry Weight EDW: 123 -Duration: 4:15 -Calcium: 2.5 -Bicarbonate: 35 b. The post treatment records for 2/14/2024 and 2/21/2024 indicated the dialysis flow rate (DFR) was at 800 (not 700 as prescribed) for the administered dialysis treatment on both days. There was no documented reason in Patient #1’s record why the prescribed DFR was not achieved 2/14/2024 and 2/21/2024. 2. On 2/27/2022 Patient #2’s record was reviewed. Patient #2 was admitted to the end-stage renal dialysis clinic (ESRD) for in-center hemodialysis on 10/06/2016. a. The dialysis prescription order dated 11/13/2023 indicated: -Hemodialysis 3x qw (three times a week). -Dialyzer: 180NRe Optiflux -Blood flow rate (BFR): 450 -Dialysate flow rate (DFR): Manual 500 -Potassium: 2.0 -Sodium: 137 -Estimated Dry Weight EDW: 84.5 -Duration: 3:00 -Calcium: 2.0 -Bicarbonate: 31 b. The post treatment records for 2/21/2024 and 2/23/2024 indicated the average blood flow rate (BFR) was 380 and 390 (not 450 as prescribed) for the administered dialysis treatments. There was no documented reason in Patient #2’s record why the prescribed BFR was not achieved 2/21/2024 and 2/23/2024. 3. On 2/27/2024 @ 2 pm the treatment records for Patient #1 and Patient #2 were reviewed with the Facility Administrator and Charge Nurse. Both confirmed the identified variances from dialysis prescription of Patient #1 and Patient #2. The Facility Administrator and Charge Nurse both acknowledged there was no documentation in both patient’s treatment records of reason for variations identified from dialysis prescription. Both stated the orders should be followed and documented if not, “any variation from the order should be documented.” 4. Review of the facility Clinical Services policy and procedure, “Patient Assessment and Monitoring” dated 5/1/2023 indicated, “...During treatment Document machine parameters and safety checks every 30 or more often as needed but not to exceed 45 minutes per state regulations...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...Document any findings and interventions in the medical record.””