Davita Marshalltown Mary Greeley 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: 39965 Based on review of procedure, medical records and staff interview, the facility failed to ensure documentation showed staff completed the CVC (Central Venous Catheter) care prior to the initiation of treatment. Failure to ensure the CVC dressing change is performed prior to the initiation of the dialysis treatment could potentially lead staff the inability of knowledge regarding cracks noted in the CVC limbs, and/or signs and symptoms of infection which could result in poor patient outcomes and/or hospitalization. The facility reported a census of 42 hemodialysis patients at the time of the survey. Findings for review of 2 of 2 (Patient #32, and Patient #29) medical records include: 1. Review of the facility policy titled “CENTRAL VENUS CATHETER (CVC) WITH CLEARGUARD HD (Hemodialysis) ANTIMICROBIAL END CAPS PROCEDURE” procedure 1-04-02B with a revision date of October 2023 provided instructions to follow regarding the CVC care(s) to be completed prior to the initiation of the dialysis treatment. 2. Review of Patient #32’s medical record included 1 dialysis treatment runsheet dated 1/1/24. Continued review showed Patient #32’s treatment was initiated at 11:16 AM with documentation to show the CVC access dressing change completed at 11:22 AM. 3. Review of Patient #29’s medical record include 6 dialysis treatment runsheets dated 1/3/24 through 1/17/24. Continued review showed the following: a. Runsheet dated 1/3/24 showed the initiation of treatment at 5:52 AM with documentation to show the CVC dressing care was performed at 5:54 AM. b. Runsheet dated 1/8/24 showed the initiation of treatment at 5:58 AM with documentation to show the CVC dressing care was performed at 6:07 AM. c. Runsheet dated 1/10/24 showed the initiation of treatment at 6:02 AM with documentation to show the CVC dressing care was performed at 7:07 AM. d. Runsheet dated 1/12/24 showed the initiation of treatment at 5:22 AM with documentation to show the CVC dressing care was performed at 5:30 AM. e. Runsheet dated 1/15/24 showed the initiation of treatment at 5:44 AM with documentation to show the CVC dressing care was performed at 5:44 AM. f. Runsheet dated 1/17/24 showed the initiation of treatment at 5:52 AM with documentation to show the CVC dressing care was performed at 5:57 AM. 4. During an interview on 1/24/24 beginning at 9:20 AM, the FA (Facility Administrator) acknowledged staff failed to ensure documentation showed the CVC dressing care was completed prior to the initiation of treatment in accordance with the facility’s procedure.”