Dci - Columbus Home 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: 03383 Based on a review of medical records, staff interview, and review of Policy and Procedures (P&P), it was determined that the medical director failed to ensure that one of one sampled patient (P#2) who experienced elevated blood pressure (BP), received medical care/interventions appropriate to the patient’s dialysis needs. The professionally accepted clinical practice standards for volume status for an adult hemodialysis patient was euvolemic (normal volume of blood or fluids in the body) and BP below 140/90 mmHg before dialysis and below 130/80 mmHg after dialysis. This was based on the Kidney Disease Outcomes Quality Initiative (KDOQI) recommendations and the Measures Assessment Tool (MAT) per Centers for Medicare and Medicaid Services - Version 2.5. Uncontrolled BP in dialysis patients can lead to severe consequences such as increased risk of heart attack, stroke, and heart failure, as the damaged kidneys are unable to regulate fluid and BP effectively, making cardiovascular complications a major concern for dialysis patients. This deficient practice had the potential to negatively affect the health and safety of 35 peritoneal dialysis (PD) patients who were under the care of this facility. Findings include: A review of “2025 Annual/Admission Peritoneal Dialysis Routine Physician Standing Orders” revealed the following: Hypertension: 1. BP of 180/90 or greater call RX (prescription) for Clonidine 0.1 mg (milligram) PO (by mouth) TID (three times a day) PRN (as needed). #30, no refills. 2. Call clinic next day or Monday if on the weekend. A review of “Clinic Visit” forms dated 11/5/24 to 12/2/24 revealed the following: On 11/5/24: - P#2’s BP was 192/123 sitting. Pre-dialysis weight was 119.3 lbs (pounds) (54.1 kg [kilogram]). The patient’s estimated dry weight was 113 lbs (51.3 kg). There was a lack of documented interventions that addressed the elevated BP. On 11/15/24: - P#2’s BP was 167/112 sitting. Pre-dialysis weight was 118.4 lbs (53.7 kg). There was a lack of documented interventions that addressed the elevated BP. On 11/25/24: - P#2’s BP was 170/105 sitting. Pre-dialysis weight was 110 lbs (50. kg). There was a lack of documented interventions that addressed the elevated BP. On 12/2/24: - P#2’s BP was 146/105 sitting. Pre-dialysis weight was 113.3 lbs (51.3 kg). There was a lack of documented interventions that addressed the elevated BP. A review of the “Hospital Discharge Summaries” showed that P#2 was hospitalized on 10/28/24 and 11/15/24 due to fluid overload. - There was a lack of documented evidence that the Interdisciplinary Care Plan dated 11/15/24 addressed elevated BP or provided coaching to address elevated BP and excess weights. During an interview on 12/18/24 at 9:49 a.m., the Area Operations Director confirmed that there were no progress notes and plan of care to show that elevated BP readings and fluid management were addressed. A review of facility Policy 11-10-28 titled, “Hypertension” last revised on 2/10/15 under Procedure Steps stated: 1. Notify nephrologist for unexplained hypertension. 2. Assess pre-dialysis weight and reassess dry weight. 3. Check: a. Vital signs b. Neck veins c. Edema d. Monitor for any of the following symptoms: headache, visual disturbance, numbness, weakness, paralysis, incontinence, shortness of breath. 4. Assess patient’s adherence to antihypertensive medication regime. 5. Ensure patient is taking antihypertensives pre-treatment.”