Renal CARE Group - Clermont

“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: 49777 Based on record review, policy review and interview the facility failed to follow the prescribed blood flow rate (BFR) for 3 patients, Patient #2, Patient #5, and Patient #13, and failed to follow the prescribed dialysate flow rate (DFR) for 1 patient, Patient #7, of 10 in center hemodialysis patients reviewed. Findings Include: Record review of Patient #2’s dialysis treatment orders, in effect 4/12/2024, revealed Patient #2 was prescribed a blood flow rate of 450. Record review of patient #2’s dialysis treatment record, dated 5/10/2024, revealed Patient #2’s blood flow rate was set at 400 seven times during his dialysis treatment on 5/10/2024. Record review of patient #2’s dialysis treatment record for 5/10/2024 failed to reveal documentation that justified or explained why Patient #2’s blood flow rate had deviated from his prescribed blood flow rate. Record review of patient #2’s dialysis treatment record, dated 5/15/2024, revealed Patient #2’s blood flow rate was set at 400 seven times throughout his dialysis treatment on 5/15/2024. Record review of patient #2’s dialysis treatment record failed to reveal documentation that justified or explained why Patient #2’s blood flow rate had deviated from his prescribed blood flow rate. Record review of Patient #5’s dialysis treatment orders, in effect 3/29/2024, revealed Patient #5 was prescribed a blood flow rate of 450. Record review of Patient #5’s dialysis treatment record, dated 5/06/2024, revealed Patient #5’s blood flow rate was set at 400 eight times during his dialysis treatment on 5/16/2024. Record review of patient #5’s dialysis treatment record for 5/06/2024 failed to reveal documentation that justified or explained why Patient #5’s blood flow rate had deviated from his prescribed blood flow rate. Record review of Patient #5’s dialysis treatment record, dated 5/08/2024, revealed Patient #5’s blood flow rate was set at 400 nine times throughout his dialysis treatment on 5/08/2024. Record review of Patient #5’s dialysis treatment record failed to reveal documentation that justified or explained why Patient #5’s blood flow rate had deviated from his prescribed blood flow rate. Record review of Patient #5’s dialysis treatment record, dated 5/15/2024, revealed Patient #5’s blood flow rate was set at 400 eight times throughout his dialysis treatment on 5/15/2024. Record review of Patient #5’s dialysis treatment record failed to reveal documentation that justified or explained why Patient #5’s blood flow rate had deviated from his prescribed blood flow rate Record review of Patient #5’s dialysis treatment record, dated 5/17/2024, revealed Patient #5’s blood flow rate was set at 400 two times and 350 five times throughout his dialysis treatment on 5/17/2024. Record review of Patient #5’s dialysis treatment record failed to reveal documentation that justified or explained why Patient #5’s blood flow rate had deviated from his prescribed blood flow rate Record review of Patient #13’s dialysis treatment orders, in effect 4/23/2024, revealed Patient #13 was prescribed a blood flow rate of 200. Record review of Patient #13’s dialysis treatment record, dated 4/23/2024, revealed Patient #13’s blood flow rate was set at 350 six times throughout his dialysis treatment on 4/23/2024. Record review of Patient #13’s dialysis treatment record failed to reveal documentation that justified or explained why Patient #13’s blood flow rate had deviated from his prescribed blood flow rate Record review of Patient #13’s dialysis treatment orders, in effect 4/25/2024, revealed Patient #13 was prescribed a blood flow rate of 400. Record review of Patient #13’s dialysis treatment record, dated 4/25/2024, revealed Patient #13’s blood flow rate was set at 350 three times and 250 one time throughout his dialysis treatment on 4/25/2024. Record review of Patient #13’s dialysis treatment record failed to reveal documentation that justified or explained why Patient #13’s blood flow rate had deviated from his prescribed blood flow rate Record review of Patient #13’s dialysis treatment record, dated 5/8/2024, revealed Patient #13’s blood flow rate was set at 300 five times throughout his dialysis treatment on 5/8/2024. Record review of Patient #13’s dialysis treatment record failed to reveal documentation that justified or explained why Patient #13’s blood flow rate had deviated from his prescribed blood flow rate During an interview on 5/22/2024 beginning at 1:38 PM, Staff B [Registered Nurse] confirmed the blood flow rate for Patient #2 was set at 400 during treatments on 5/10/20204 and 5/15/2024. Staff B also stated, “A deviation from a patient’s prescribed blood flow rate or dialysate flow rate should always be justified with documentation in the clinical record.” During an interview on 5/22/2024 beginning at 1:38 PM, Staff B [Registered Nurse] confirmed the blood flow rate for Patient #5 was set at 350 during treatments on 5/6/2024, 5/8/2024, 5/15/2024, and 5/17/2024. Staff B also stated, “ A deviation from a patient’s prescribed blood flow rate or dialysate flow rate should always be justified with documentation in the clinical record.” During an interview on 5/22/2024 beginning at 1:38 PM, Staff B [Registered Nurse] confirmed the blood flow rate for Patient #13 was set at 350 during treatments on 4/23/2024 and 4/25/2024 and set at 300 during treatments on 5/8/2024. Staff B also stated, “ A deviation from a patient’s prescribed blood flow rate or dialysate flow rate should always be justified with documentation in the clinical record.” Record review of the facility policy titled “Unable to Achieved Prescribed Blood Flow Rate”, published 11/1/2021, showed the policy read “Achieving prescribed BFR is a critical parameter in achieving adequate treatment Kt/V [clearance time / volume]. Staff, patient and/or care partner will recognize and report to the nurse in charge the inability to achieve prescribed blood flow rate. Notify the physician/extender if unable to achieve prescribed blood flow rate. Document in patient’s treatment record what action taken to address the inadequate blood flow rate and if unable to resolve. The nurse shall document any physician orders.” Record review of Patient #7’s Hemodialysis order, dated 3/29//2024, revealed Patient #7’s prescribed dialysate flow rate was 500. Record review of Patient #1’s dialysis treatment record, dated 5/6/2024, revealed Patient #7’s dialysate flow rate was set at 800 eight times during her treatment on 5/6/2024. Record review of Patient #7’s dialysis treatment record, dated 5/8/2024, revealed Patient #7’s prescribed dialysate flow rate was 500. Record review of Patient #1’s dialysis treatment record, dated 5/6/2024, revealed Patient #7’s dialysate flow rate was set at 800 six times during her treatment on 5/8/2024. Record review of Patient #7’s dialysis treatment record, dated 5/10/2024, revealed Patient #7’s prescribed dialysate flow rate was 500. Record review of Patient #1’s dialysis treatment record, dated 5/10/2024, revealed Patient #7’s dialysate flow rate was set at 800 seven times during her treatment on 5/10/2024. Record review of Patient #7’s dialysis treatment record, dated 5/13/2024, revealed Patient #7’s prescribed dialysate flow rate was 500. Record review of Patient #1’s dialysis treatment record, dated 5/13/2024, revealed Patient #7’s dialysate flow rate was set at 800 eight times during her treatment on 5/13/2024. Record review of Patient #7’s dialysis treatment record, dated 5/15/2024, revealed Patient #7’s prescribed dialysate flow rate was 500. Record review of Patient #1’s dialysis treatment record, dated 5/15/2024, revealed Patient #7’s dialysate flow rate was set at 800 five times during her treatment on 5/15/2024. Record review of Patient #7’s dialysis treatment record, dated 5/17/2024, revealed Patient #7’s prescribed dialysate flow rate was 500. Record review of Patient #1’s dialysis treatment record, dated 5/17/2024, revealed Patient #7’s dialysate flow rate was set at 800 nine times during her treatment on 5/17/2024. Record review of Patient #7’s dialysis treatment records failed to reveal documentation that justified or explained why Patient #7’s dialysate flow rate had deviated from his prescribed dialysate flow rate. During an interview on 5/22/2024 beginning at 1:38 PM, Staff B [Registered Nurse] confirmed the dialysate flow rate for patients #2 was set at 800 during treatments on 5/8/24, 5/10/24, 5/13/24, 5/15/24, and 5/17/24. Staff B also stated, “ A deviation from a patient’s prescribed blood flow rate or dialysate flow rate should always be justified with documentation in the clinical record.” Record review of the facility policy titled “Unable to Achieved Prescribed Blood Flow Rate”, published 11/1/2021, showed the policy read “Achieving prescribed BFR is a critical parameter in achieving adequate treatment Kt/V [clearance time / volume]. Staff, patient and/or care partner will recognize and report to the nurse in charge the inability to achieve prescribed blood flow rate. Notify the physician/extender if unable to achieve prescribed blood flow rate. Document in patient’s treatment record what action taken to address the inadequate blood flow rate and if unable to resolve. The nurse shall document any physician orders.””