Davita Osceola Loop Dialysis

“IC-STAFF EDUCATION-CATHETERS/CATHETER CARE CFR(s): 494.30(a)(2) Recommendations for Placement of Intravascular Catheters in Adults and Children I. Health care worker education and training A. Educate health-care workers regarding the ... appropriate infection control measures to prevent intravascular catheter-related infections. B. Assess knowledge of and adherence to guidelines periodically for all persons who manage intravascular catheters. II. Surveillance A. Monitor the catheter sites visually of individual patients. If patients have tenderness at the insertion site, fever without obvious source, or other manifestations suggesting local or BSI [blood stream infection], the dressing should be removed to allow thorough examination of the site. Central Venous Catheters, Including PICCs, Hemodialysis, and Pulmonary Artery Catheters in Adult and Pediatric Patients. VI. Catheter and catheter-site care B. Antibiotic lock solutions: Do not routinely use antibiotic lock solutions to prevent CRBSI [catheter related blood stream infections]. This Standard is not met as evidenced by: 39943 Based on observation and interview, the facility failed to properly clean the exit site of a Central Venous Catheter (CVC) for one of two patients observed for CVC exit site care (1). Findings: Patient #1 was admitted to the facility on 12/10/21 with diagnoses to include acute kidney failure and diabetes type 2. On 7/21/25 at 11:15 AM, Patient Care Technician (PCT) A was observed with patient #1 prepping the CVC for initiation of dialysis. The PCT was preparing to clean the catheter exit site. The PCT began cleaning the skin further from the catheter exit site and cleaning toward the exit site with the exit site being the last part of the cleaning procedure. Review of the Hemodialysis Procedural Skills Checklist, (education provided to the staff prior to working with patients) dated 3/29/19, read to begin the cleaning at the exit site and progress to the outer skin around the site. On 7/22/24 at approximately 2:30 PM, the Facility Administrator stated the proper way to clean a CVC is to begin at the exit site of the catheter and scrub away from the site. The “Central Venous Catheter (CVC) with Clearguard HD Antimicrobial End Caps Procedure” policy dated 4/19 and revised 10/22 and 4/23 read: ...swab for a minimum of 30 seconds, apply to the CVC exit site in a “back and forth” pattern, using gentle friction progressing from the insertion site to the periphery ...”

“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: 39943 Based on observation, interview and record review, the dialysis facility failed to follow hemodialysis orders and failed to provide documentation for not following the prescribed blood flow rate (BFR) and dialysis flow rate (DFR) for 4 of 6 patients reviewed for dialysis prescription, (#1,#2,#3,#6). Findings: 1. Patient #1 was admitted to the facility on 12/10/21 with diagnoses to include acute kidney failure and diabetes type 2. Review of the record revealed treatment orders dated 4/29/25 to include an estimated dry weight of 68.5 kilograms (kg), treatment of 3 days a week, 3 hours and 00 minutes duration per treatment, dialyzer of Fresenius Optiflux F180NR, Blood Flow Rate (BFR) of 400 milliliter/minute (ml/min) and Dialysate Flow Rate (DFR) of 500 ml/min. She had a Central Venous Catheter (CVC) in her right upper chest. On 07/02/25, patient #1 had her dialysis treatment from 10:24 AM-1:30 PM. The BFR was set at 350 ml/min for the duration of the treatment. There was no documented reason why the BFR was set at that rate. On 07/04/25, patient #1 had her treatment from 10:51 AM-1:52 PM. The BFR was set 400 ml/min when started and changed to 300 ml/min.at 11:25 until the end of the treatment. There was no documented reason why the BFR rate was changed. On 07/09/25, patient #1 had her treatment from 10:38 AM-1:39 PM. The DFR was set at 500 ml/min at the start of the treatment and changed to 610 ml/min at 11:09 AM for the duration of the treatment. There was no documented reason why the DFR rate was changed. On 07/14/25, patient #1 had her treatment from 10:44 AM-1:43 PM. The DFR was set at 500 ml/min at the start of the treatment and changed to 810 ml/min at 11:15 AM for the duration of the treatment. There was no documented reason why the DFR rate was changed. 2. Patient #2 was admitted on 07/12/24. The cause of kidney failure was diabetes. Review of the record revealed treatment orders dated 6/23/25 to include an estimated dry weight of 73.5 kilograms (kg), treatment of 3 days a week, 3 hours and 15 minutes duration per treatment, dialyzer of Fresenius Optiflux F180NR, Blood Flow Rate (BFR) of 350 milliliter/minute (ml/min)) and Dialysate Flow Rate (DFR) of 500 ml/min. She had an arteriofistula (AVF) access on left upper arm. On 07/02/25, patient #1 had her treatment from 11:01 AM-2:27 PM. The DFR was set between 600-610 ml/min throughout the duration of the treatment. There was no documented reason why the DFR was set at that rate. On 07/04/25, patient #1 had her treatment from 10:22 AM-12:57 PM. The DFR was set between 590-620 ml/min throughout the duration of the treatment. There was no documented reason why the DFR was set at that rate. On 07/09/25, patient #1 had her treatment from 10:55 AM-2:12 PM. The DFR was set between 600-610 ml/min throughout the duration of the treatment. There was no documented reason why the DFR was set at that rate. On 07/16/25, patient #1 had her treatment from 11:13 AM-2:34 PM. The DFR was set between 590-610 ml/min throughout the duration of the treatment. There was no documented reason why the DFR was set at that rate. The Registered Nurse documented verification that the patient’s prescription matched what was currently being delivered during the dialysis treatment for all the above treatments. On 7/22 /25 at approximately 2:30 PM, the Facility Administrator confirmed there should be a documented note when a patient’s prescription is not being followed as ordered. 13640 3. On 7/212/25 at 10:48 AM, observation of the hemodialysis treatment for patient #6 revealed the blood flow rate setting on the machine was at 350 ML/MIN (milliliters per minute). However, physician orders dated 6/30/25 indicated that the patient was to heve hemodialysis treatment with a blood flow rate of 400 ML/MIN. During an interview with Patient Care Tech A (PCT) she was asked why the orders for 400 ML/MIN were not followed. She stated it was because the patient’s catheter was not working. A review of the Treatment Details Report revealed that the patient began hemodialysis treatment on 7/21/25 at 7:48 AM and the treatment was completed at 10:47 AM. During this time interval, a blood flow rate of 350 ML/MIN was mentioned seven times. There was no mention of the ordered 400 ML/MIN and why it was not followed. 4. A review of the medical record of patient #3 revealed physician orders of 6/12/25 for a dialysate flow rate of 500 ML/MIN. A review of the treatment details report of 7/18/25 revealed that the patient started hemodialysis treatment at 11:23 AM and the treatment ended at 3:20 PM. During this time interval, the dialysate flow rate was documented at the following levels: 590, 600 and 610 ML/MIN. At no point was 500 ML/MIN documented. Furthermore, there were no explanations in the treatment details report as to why the orders for 500 ML/MIN were not followed. During an interview of the Administrator on 7/22/25 at 12:20 PM, she confirmed the preceding. A review of facility policy Pre-Intra-Post Treatment Data Collection, Monitoring and Nursing Assessment revealed the following: “If the dialysis prescription is not being met (including dialysis flow rate or change to / inability to obtain prescribed blood flow rate) the reason will be documented and the licensed nurse informed.” Thus, the facility was not in compliance with this policy.”