Davita Council Bluffs Dialysis Center

“PA-APPROPRIATENESS OF DIALYSIS RX CFR(s): 494.80(a)(2) The patient’s comprehensive assessment must include, but is not limited to, the following: (2) Evaluation of the appropriateness of the dialysis prescription, This Standard is not met as evidenced by: 44475 Based on facility policy, medical record review, and staff interview, the facility failed to ensure the prescribed dialysis BFR (Blood Flow Rate) was administered to 2 of 5 hemodialysis patients (Patients #1 and #2). The facility reported a census of 63 in center hemodialysis patients at the time of the survey. Findings include: 1. The facility policy titled “Pre-Intra-Post Treatment Data Collection, Monitoring and Nursing Assessment” last revised April 2024 directed, in part, that if the dialysis prescription is not being met (including dialysis flow rate or change to/inability to obtain blood flow rate) the reason will be documented. 2. Review of the Treatment Details Report of Patient #1 and Patient #2 showed the following: a. The Treatment Details Report on 4/9/25 for Patient #1 revealed an ordered BFR of 400 mL/min (milliliters per minute). Patient #1’s Treatment Details report showed a BFR of 350 mL/min from 12:12 PM to 3:40 PM. b. The Treatment Details Report on 4/11/25 for Patient #1 revealed an ordered BFR of 400 mL/min. Patient #1’s Treatment Details report showed a BFR of 250 mL/min from 11:49 AM to 3:27 PM. . c. The Treatment Details Report on 4/9/25 for Patient #2 revealed an ordered BFR of 350 mL/min. The patient’s BFR was documented at 400 mL/min from 10:34 AM to 2:33 PM. d. The Treatment Details Report on 4/19/25 for patient #2 revealed an ordered BFR of 350 mL/min. The patient’s BFR was documented at 400 mL/min from 12:01 PM to 2:46 PM. e. The Treatment Details Report on 4/21/25 for patient #2 revealed an ordered BFR of 350 mL/min. The patient’s BFR was documented at 400 mL/min from 10:34 AM to 2:45 PM. 3. In an interview on 4/29/25 at 10:47 AM, Staff G, Manager of Clinical Services, reported the facility should have obtained an updated order for the BFR needed to run considering the access the patient used.”

“POC-MANAGE ANEMIA/H/H MEASURED Q MO CFR(s): 494.90(a)(4) The interdisciplinary team must provide the necessary care and services to achieve and sustain the clinically appropriate hemoglobin/hematocrit level. The patient’s hemoglobin/hematocrit must be measured at least monthly. The dialysis facility must conduct an evaluation of the patient’s anemia management needs. This Standard is not met as evidenced by: 44475 Based on facility policy, medical record review, and staff interview, the facility failed to follow prescription orders for Venofer (a medication used treatment for iron deficiency anemia) for 3 of 5 in center hemodialysis patients (Patient 1, 2, and 3). The facility reported a census of 63 in center hemodialysis patients at the time of the survey. Findings include: 1. The facility policy titled, “Medication Policy” last revised October 2023 directed, in part, that medications are administered as prescribed and then documented in the patient’s medical record. Prior to administration of medication, verify physician or NPP (non-physician practitioner) order. 2. The Patient Summary Report for Patient #1 revealed an order for Venofer 50 milligrams (mg) one time a week, with a start date of 8/20/24. Closer review of the Treatment Details report for Patient #1 showed the following: a. The Treatment Details Report dated 4/14/25 revealed the patient received Venofer 50 mg. b. The Treatment Details Report dated 4/16/25 revealed the patient received Venofer 50 mg (twice within the same week). 3. The Patient Summary Report for Patient #2 revealed an order for Venofer 50 milligrams (mg) one time a week with a start date of 4/9/25. Closer review of the Treatment Details report for Patient #2 showed the following: a. The Treatment Details Report dated 4/14/25 revealed the patient received Venofer 50 mg. b. The Treatment Details Report dated 4/18/25 revealed the patient received Venofer 50 mg (twice within the same week). 4. The Patient Summary Report for Patient #3 revealed an order for Venofer 50 milligrams (mg) one time a week, with a start date of 12/2/24. Closer review of the Treatment Details report for Patient #3 showed the following: a. The Treatment Details Report dated 4/14/25 revealed the patient received Venofer 50 mg. b. The Treatment Details Report dated 4/17/25 revealed the patient received Venofer 50 mg ( twice within the same week). 5. In an interview on 4/29 at 11:54 AM, Staff G, Manager of Clinical Services, reported the facility should have looked at the paper charting to ensure accuracy.”