Mayo Clinic Hosp-Dyls

“IC-WEAR GLOVES/HAND HYGIENE CFR(s): 494.30(a)(1) Wear disposable gloves when caring for the patient or touching the patient’s equipment at the dialysis station. Staff must remove gloves and wash hands between each patient or station. This Standard is not met as evidenced by: 36083 Based on documents review, observations, and interviews, the facility failed to maintain clear separation of clean and dirty areas at the dialysis treatment stations, wherein 4 of 4 staff members (patient care technician [PCT] B, PCT C, registered nurse [RN] A, RN F) were using gloves placed together with miscellaneous items on the island countertops at 5 of 9 dialysis stations (Station #9, #8, #5, #2, and #1). The facility reported a census of 20 in-center dialysis patients at the time of the survey. Findings include: 1. The policy titled, “Central venous access device dressing change” revised on 8/19/24, provides that vascular catheters are at risk for “hospital-acquired condition” and directs staff members to follow evidence-based practices to prevent infection, such as setting up a sterile field during dressing changes and use of sterile gloves. 2. The dialysis facility report (DFR) identified the facility with a higher rate than the national threshold for the use of long term (greater than 90 days) central venous catheter (CVC). During the survey entrance, the facility also provided a document that showed current data with 8 of 20 patients having CVC longer than 90 days. 3. Observations on 11/19/24, showed the following: -At 9:04 AM, PCT B pulled a handful of gloves from boxes attached to the wall by Station #9, and placed them on the island countertop, where 2 open heparin vials (carried from the medication cabinets at the nurses’ station), a bottle of hand sanitizer, a canister of disinfectant wipes, a thermometer, and writing pens. PCT B donned gloves from the gloves placed on the island countertop, touched Patient #6’s CVC connection site to disconnect from treatment. PCT B wiped Patient #6’s CVC ports, injected heparin, and applied new caps to the CVC. PCT B changed gloves, taking another pair from the stack of gloves on the countertop and proceeded to wrap Patient #6’s catheter ports/limbs. -At 9:35 AM, PCT B was at Station #8 in the process of disconnecting Patient #7’s CVC after completion of a dialysis treatment. PCT B donned gloves obtained from the island countertop, which were placed with a sheet of paper, and worked on touching Patient #7’s CVC lines, connection sites, and ports. -At 9:30 AM, RN A was at Station #5 working to initiate dialysis thru an arteriovenous fistula (AVF) for Patient #5. RN A used gloves from a stack lying with a bottle of hand sanitizer, a canister of disinfectant wipes, a sheet of paper, a thermometer on the bare island countertop. -At 10:09 AM, PCT C set up Station #1 for the initiation of Patient #3’s dialysis treatment. PCT C then placed gloves on the bare island countertop adjacent to the dialysis Station. -At 10:58 AM, several gloves were piled on top of the computer keyboard on the island countertop at Station #2. The gloves were also in contact with sheets of paper lying on the same island countertop. RN F used the gloves from the countertop to assess Patient #8 and PCT B used gloves from the same stack to initiate Patient #8’s dialysis treatment. 4. During an interview on 11/19/24 at 4:20 PM, the nurse manager (NM) reported that the facility had 1 case of blood stream infection related to dialysis access, for the year. The NM acknowledged that staff members were instructed to put the gloves on the countertops to minimize going around the patient in order to reach the location of the gloves’ containers attached to the wall (behind the patient). The NM stated that everything (including computer keyboard, containers of sanitizers and disinfectant, thermometers) contained on the island countertops were sanitized after patients’ treatments, and that everything in the station is “clean” and individualized patient’s use. However, the NM acknowledged that the sheets of paper and other items taken to the countertops could not be sanitized and should not be mixed together with clean items such as gloves.”

“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: 36083 Based on documents review, and interviews, the facility did not follow dialysis prescription for 1 of 5 patients (Patient #4) in the sample for medical records for 2 of 13 dialysis treatments (8/10/24 and 10/3/24). The facility reported a census of 20 in-center hemodialysis patients at the time of the survey. Findings include: 1. The policy titled, “Outpatient Hemodialysis Patient Observation and Assessment Procedure” dated 12/7/23, directs the staff members to ensure patient achieves and maintains the prescribed blood flow rate. 2. Patient #4’s medical records showed dialysis order dated 10/3/24 to include treatment time of 4 hours, and a blood flow rate (BFR) as tolerated to a maximum of 350. 3. Patient #4’s dialysis treatment flowsheets showed that on 8/8/24, Patient #4 started to dialyze at 6:30 AM with a BFR of 400 and went through dialysis with the same BFR until 10:00 AM (3.5 hours). On 10/3/24, Patient #4’s dialysis treatment flowsheets showed that at 6:52 AM, the BFR was at 400 until 10:21 AM (3.5 hours). 4. During medical records review on 11/19/24 at 3:02 PM, registered nurse (RN) F stated that Patient #4’s prescribed BFR was 350, which was carried over when Patient #4 returned for treatment on 10/3/24, following hospitalization. RN F verified that the prescribed BFR was not followed on 8/8/24 and on 10/3/24 as shown in Patient #4’s treatment flowsheets. 5. During interview on 11/20/24 at 2:42 PM, the nurse manager (NM) verified that Patient #4’s order for BFR was not implemented on 8/8/24 and 10/3/24. The NM acknowledged the importance of following dialysis orders.”