Davita Jacksonville Arlington Dialysis

“H-PT/CAREGIVER DEMO COMPREHEND TRAINING CFR(s): 494.100(b)(1) The dialysis facility must - (1) Document in the medical record that the patient, the caregiver, or both received and demonstrated adequate comprehension of the training; This Standard is not met as evidenced by: 42310 Based on record review, interviews, and facility policy review, the facility failed to ensure documentation in the medical record indicated the patient, the care partner, or both received and demonstrated adequate comprehension of the Home Hemodialysis (HHD) training for 1 (Patient #1) of 3 patients sampled. Findings include: 1) Patient #1 was a 47-year-old female with a recent diagnosis of End Stage Renal Disease (ESRD) requiring hemodialysis. The patient was approved by the facility medical director to participate in the HHD program with a Care Partner (her mother). The training program required attendance, return demonstrations, testing, and a final evaluation at home, unassisted but observed by the facility HHD training nurse. Training consisted of approximately 14 treatments over five weeks, with facility forms requiring initials and/or signatures from the HHD training nurse, the patient, and the Care Partner. During the record review of Patient #1, it was discovered that documentation indicating completion by the patient and the Care Partner was incomplete. The following issues were identified: 1a) Home Hemodialysis (HHD) Epogen Self-Administration & IV Self-Administration Patient Education Tool/Agreement Form Education and agreement related to this topic required signatures from the HHD training nurse, the patient, and the Care Partner. This form did not have signatures from the patient or the Care Partner. 1b) HHD Epogen Subcutaneous & IV Self-Administration Skill Checklist There were 35 skills listed to be validated by both the patient and the Care Partner. Each skill required one demonstration by the HHD training nurse and two separate return demonstrations, each return demonstration by the patient and by the Care Partner. Documentation indicated that each skill, at the time of demonstration, required initials by the HHD training nurse. The form also included a section for the patient and the Care Partner to sign and date, indicating they had completed the education for that area. However, there were no initials by the HHD training nurse (each of the 35 skills × 3 = 105 opportunities missed), and the documentation was not signed by either the patient or the Care Partner. 1c) Intradialytic Parenteral Nutrition (IPDN) Patient Education Tool/Agreement Form Education and agreement related to this topic required signatures from the HHD training nurse, the patient, and the Care Partner. This form did not have signatures from the patient or the Care Partner. 1d) Intradialytic Parenteral Nutrition (IPDN) Skills Checklist There were 9 skills listed to be validated by both the patient and the Care Partner. Each skill required one demonstration by the HHD training nurse and two separate return demonstrations, each return demonstration by the patient and by the Care Partner. Documentation indicated that each skill, at the time of demonstration, required initials by the HHD training nurse. The form also included a section for the patient and the Care Partner to sign and date, indicating they had completed the education for that area. However, there were no initials by the HHD training nurse (each of the 9 skills × 3 = 27 opportunities missed), and the documentation was not signed by either the patient or the Care Partner. 1e) HHD IV Iron Self-Administration Patient Education/Agreement Form Education and agreement related to this topic required signatures from the HHD training nurse, the patient, and the Care Partner. This form did not have signatures from the patient or the Care Partner. 1f) HHD IV Iron Self-Administration Skills Checklist There were 25 skills listed to be validated by both the patient and the Care Partner. Each skill required one demonstration by the HHD training nurse and two separate return demonstrations, each return demonstration by the patient and by the Care Partner. Documentation indicated that each skill, at the time of demonstration, required initials by the HHD training nurse. The form also included a section for the patient and the Care Partner to sign and date, indicating they had completed the education for that area. However, there were no initials by the HHD training nurse (each of the 25 skills × 3 = 75 opportunities missed), and the documentation was not signed by either the patient or the Care Partner. 1g) HHD IV Antibiotic Self-Administration Education Tool/Agreement Form Education and agreement related to this topic required signatures from the HHD training nurse, the patient, and the Care Partner. This form did not have signatures from the patient or the Care Partner. 1h) HHD IV Antibiotic Self-Administration Skills Checklist There were 20 skills listed to be validated by both the patient and the Care Partner. Each skill required one demonstration by the HHD training nurse and two separate return demonstrations, each return demonstration by the patient and by the Care Partner. Documentation indicated that each skill, at the time of demonstration, required initials by the HHD training nurse. The form also included a section for the patient and the Care Partner to sign and date, indicating they had completed the education for that area. However, there were no initials by the HHD training nurse (each of the 20 skills × 3 = 60 opportunities missed), and the documentation was not signed by either the patient or the Care Partner. On 12/15/25 at 12:45 PM, an interview was conducted with Employee A, RN - HHD Training Nurse. Employee A confirmed that he did not always initial where required and did not always obtain signatures from Patient #1 or the Care Partner. He acknowledged these were required items On 12/15/25 at 3:00 PM, an interview was conducted with the Senior Manager of Clinical Services. She confirmed the missing HHD training nurse initials and the missing required signatures from Patient #1 and the Care Partner. She stated these were required elements to ensure both the patient and the Care Partner were trained and proficient in conducting Home Hemodialysis. A Review of the facility policy related to Home Hemodialysis indicated that all training must be signed by the HHD training nurse, the patient, and the Care Partner if a Care Partner was required.”