Davita Celebration Dialysis

“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: 13640 Based on observation, interview, and record review, the facility failed to ensure the provision of the necessary care and services as ordered by the physician for dialysate bath, dialysate flow rate and blood flow rate in three of seven sampled patients, (#3, #6, and #7). Findings: Review of patient #7’s medical record revealed physician orders of 6/25/25 read: “Dialysate Bath: Acid - 2K (potassium) - 3.0 Ca (Calcium), Liquid Citrate.” During an observation of patient #7 on 8/18/25 at 9:50 AM, he was observed to be undergoing his hemodialysis treatment. The dialysis machine bath settings were observed to be 2K (potassium) and 2.5 Ca (calcium).” Thus, the physician orders were not being followed. On 8/18/25 at 9:50 AM, the Clinical Coordinator stated she could not explain why the physician orders had not been followed. Review of the Treatment Details Report dated 8/18/25 revealed the patient started hemodialysis treatment at 8:23 AM, and ended treatment at 12:37 PM. There were no entries in the medical record which gave a justification for the patient receiving a different dialysate bath than what the physician ordered. A review of the facility policy, Pre-Intra-Post Treatment Data Collection, Monitoring and Nursing Assessment revealed the following: “Patient identity, prescription and machine settings are verified by teammate prior to initiation of treatment. . . Prescription components include but are not necessarily limited to: . . Correct dialysate composition (potassium, calcium, base sodium and bicarb [bicarbonate]. . . “ The facility was not in compliance with this policy. On 8/19/25 at 2:30 PM, the Administrator confirmed the physician orders were not followed for patient #7. 45576 2. Record review of patient #3’s physician orders dated 7/16/25 noted a Blood flow rate (BFR) of 400 milliliters/minute (ml/min) and a Dialysis flow rate (DFR) of 500 ml/min. Record review of patient #3’s dialysis treatment record dated 8/06/25 revealed patient #3 was prescribed a BFR of 450 ml/min Record review of patient #3’s dialysis treatment record dated 8/08/25 revealed patient #3 was prescribed a DFR of 610 ml/min. 3. Record review of patient #6’s physician orders dated 8/11/25 read “Blood flow rate 400.0 ml/min. Dialysis flow rate 800 ml/min.” The treatment record dated 8/6/25 noted the prescribed BFR of 400 mil/min. Further review of the patients treatment revealed a BFR of 350 ml/min was documented eight times during the treatment on 8/6/25. The staff failed to document why the physician’s prescribed BFR was not followed. Patient #6’s treatment record dated 8/8/25 noted the patient was being treated with BFR of 350 ml/min which is contrary to he physicians order. There was not any documented evidence why lower BFR was being used to treat patient #6. Review of patient #6’s treatment records dated 7/28/25, 7/30/25, 8/1/25, 8/6/25, 8/8/25 and 8/11/25 noted DFR of 300 ml/min, 300 ml/min, 610 ml/min, 300 ml/min, 500 ml/min, 600 ml/min and 810 ml/min, respectively. There was not any evidence to support why the staff did not follow the physician prescribed DFR. On 8/20/25 at 4:20 PM, Technician B stated, “I was having trouble with the flow of her [Patient #6’s] catheter, I should have documented why the flow was not running as ordered.” On 8/20/025 at 4:30 PM, Registered Nurse (RN) A stated, “We were having a problem with her [Patient #6’s] flow. We should have documented the problem and notified that nephrologist.” On 8/20/25 at 4:40 PM, the Clinical Coordinator RN stated the physician orders for BFR and DFR flow rates were not followed because of an issue with flow. The nurse explained the problem should have been documented in the notes with the reason why the BFR and DFR were not completed as the physician ordered. On 8/20/25 at 5:00 PM, the Facility Administrator acknowledged physician’s orders related to blood flow rate and dialysate flow rate had not been followed consistently. The Administrator confirmed staff should have verified the patient’s blood and dialysate flow rates and documented the reason for any deviation from the prescription.”