Fmc - Ottumwa

“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: 36083 Based on documents review, observations, and interviews, the facility did not ensure dialysis treatments as prescribed for 2 of 4 patients (Patient #8 and Patient #9) in the sample observed for prescription verification at the in-center hemodialysis unit. The facility also did not ensure correct blood flow rate and dialysis flow rate for 2 of 5 in-center hemodialysis patients in the sample for review of medical records (Patient #3 and Patient #4). At the time of the survey, the facility reported a census of 39 in-center hemodialysis patients. Findings include: 1. The policy titled, Pre-Treatment Safety Checks Procedure, published 2/06/2023, provides guidance on performing safety checks prior to initiating hemodialysis treatment. The policy indicates that 2 staff members are to verify prior to initiation of treatments including the prescribed dialyzer and dialysate flow rate. The policy also provides that after the patient is seated, the clinician initiating the treatment must verify the prescribed set up matches the patient, including the dialyzer, dialysate flow rate, and temperature. 2. During observation on 6/16/25 at 1:45 PM, Patient #8 had an ongoing dialysis treatment at Station #15, with a dialyzer labeled, “Optiflux F180 NRe” and the dialysis machine indicated 1 hour and 22 minutes remaining time for treatment. Patient #8’s dialysis prescription noted on the dialysis machine showed “Optiflux F160 NRe” dialyzer and a treatment time for 3 hours and 30 minutes. Patient Care Technician (PCT) C, who was present during the observation, verified that Patient #8 was dialyzing with an incorrect dialyzer. PCT C also verified Patient #8 had been on treatment for more than 2 hours. Patient #8’s treatment flowsheet on 6/16/25, showed under an order for 160 NRe Optiflux dialyzer. 3. During observation on 6/16/25 at 2:45 PM, Patient #9 was on dialysis treatment at Station #8, with the machine temperature set at 36. However, Patient #9’s dialysis prescription showed an order for temperature setting at 37. Registered Nurse (RN) A verified the discrepancy of the temperature on the actual machine setting and the prescription. RN A said, “It is an error, I will let [the doctor] know.” 4. Patient #4’s treatment sheets showed incorrect blood flow rate (BFR), as follows: a) On 6/4/25, Patient #4’s treatment sheet showed an order for blood flow rate (BFR) of 450. However, the treatment sheet indicated that Patient #4 dialyzed with a 350 BFR for the whole duration of treatment or from 11:16 AM to 2:23 PM. b) On 6/9/25, Patient #4’s treatment sheet showed an order for BFR of 450, but Patient #4 dialyzed with a BFR of 350 for the whole duration of treatment from 10:50 AM to 1:51 PM, as documented in the same treatment sheet. 5. Patient #3’s treatment sheets showed incorrect dialysate flow rate (DFR) as follows: a. On 6/4/25, Patient #3’s treatment sheet showed an order for a DFR of 500. However, the treatment sheet indicated that Patient #3 dialyzed with an 800 DFR for their entire 3-hour treatment. b. On 6/13/25, Patient #3’s treatment sheet showed an order for a DFR of 500. However, the treatment sheet indicated that Patient #3 dialyzed with a 600 DFR for their entire 3-hour treatment. 6. On 6/18/25 at 10 AM, the medical director (MD) indicated treatments that are not delivered as prescribed are errors, which should not happen. The MD stated expectations that staff follow patients’ dialysis orders. 51639”