Fmc - Palatine Dialysis Center

“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: 40079 Based on observation, document review, and interview, it was determined that for 4 of 6 staff (E#3, E#4, E#5, and E#6) observed for hand hygiene, the Facility failed to ensure that staff changed gloves and/or performed hand hygiene as required. Findings include: 1. During a tour of the dialysis treatment area on 05/05/2025 between 9:35 AM and 10:45 AM, the following was observed: -At 9:53 AM, a Patient Care Technician/PCT (E#3) was initiating dialysis for a patient at station #12. E #3 was observed working on the dialysis machine’s computer screen with gloved hands, while holding the dialysis lines. E #3, then turned to the patient and connected the lines to a Arteriovenous Fistula (AVF) ports. E #3 did not change gloves and did not perform hand hygiene prior to connecting dialysis lines. -At 10:00 AM, a PCT (E#4) was at station #14 working on the dialysis machine’s computer screen while holding the dialysis lines. E#4 then proceeded to connect the dialysis lines to the AVF without performing hand hygiene. -At 10:05 AM, a Registered Nurse (RN/E#5) was observed throwing trash into a trash receptacle with gloved hands, E#5 then removed their gloves and threw them away and put on a new pair of gloves. E#5 then went to station #3 and worked on the dialysis machine’s computer, then went to station #9 and worked on that computer. E#5 removed their gloves after working at station #9 and proceeded to the nurses’ station and worked on the computer. E#5 did not perform hand hygiene in between tasks and after removing contaminated gloves. -At 10:10 AM, a PCT (E#6) was initiating dialysis for a patient at station #2. E#6 was priming the dialysis lines into the bucket with gloved hands, then turned to work on the dialysis machine’s computer screen. E#6 then proceeded to connect the dialysis lines to the AVF ports, E#6 did not perform hand hygiene between tasks. 2. The facility’s policy titled, “Hand Hygiene” (revised 11/06/2023) was reviewed and required, “All staff ... must follow the same requirements for hand hygiene: ... Before and after direct contact with patients ... Immediately after removing gloves... After contact with inanimate objects near the patient ...” 3. An interview was conducted with the Clinical Manager (E #1) on 05/06/2025, at approximately 1:50 PM. E #1 stated that all staff must perform hand hygiene after removing gloves, touching the dialysis screens or inanimate objects, and before accessing any vascular access or performing a new task.”

“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: 39802 Based on document review and interview, it was determined that for 1 of 2 home hemodialysis (HHD) patients (Pt. #10) reviewed, the facility failed to ensure that dialysis and medication prescription orders were followed. Findings include: 1. The facility’s policy titled, “Home Program Guidelines” (revised 11/04/2024), was reviewed and required “...The Home Program must verify that the interventions for treatments and medication administration checked in the clinical system match the actual days that treatments/medications were performed/administered by the patient or in-facility back-up treatments were provided...” 2. The clinical record of Pt. #10 was reviewed on 05/06/2025 at 1:07 PM. Pt. #10 was admitted on 04/22/2024 with a diagnosis of end-stage renal disease. A dialysis prescription order, dated 01/20/2025, included “Home HD using NxStage with PureFlow 4x [per] week... [Dialysate] Volume per tx [treatment]: 40 L [liters]...” A medication prescription order, dated 01/21/2025, included “Heparin [blood thinner]... Bolus 4000 units IVP [intravenous push] every treatment...” Treatment records from 02/16/2025-02/28/2025 were reviewed and indicated the following: - All treatment records lacked documentation that a heparin bolus was administered as ordered. - The treatment flowsheet, dated 02/16/2025, included a total dialysate volume processed of 35.8 L and lacked documentation as to why the prescribed 40 L was not met. - The treatment flowsheet, dated 02/22/2025, included a total dialysate volume processed of 25.9 L and lacked documentation as to why the prescribed 40 L was not met. - The treatment flowsheet, dated 02/28/2025, included a total dialysate volume processed of 30.4 L and lacked documentation as to why the prescribed 40 L was not met. - Nursing notes from 02/16/2025-05/06/2025 were reviewed and lacked documentation as to why the prescription volumes were not met and whether the issue was addressed with the patient/caregiver performing treatments. 3. An interview was conducted with Home Therapy Nurse (E#7) on 05/06/2025, at approximately 2:00 PM. E#7 stated that Pt. #10 has been trained to administer the heparin; however, they just need to train Pt. #10 on how to enter medications administered prior to starting treatment. E#7 stated that it must be entered manually. E#7 stated that E#7 verifies the treatment records from the previous day daily. E#7 stated that the patient will call if they were unable to administered a medication. E#7 stated that on the dates the volume was not met, there was a lot of alarms going off which could indicate a problem with the access. E#7 stated that they should have documented a note to address why the prescription was not met and any issues that may have caused the alarms.”

“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: 40079 Based on document review and interview, it was determined that for 2 of 6 (Pt. #4 and Pt. #5) in-center hemodialysis clinical records reviewed for intradialytic monitoring, the Facility failed to ensure that the staff provided necessary care and services to manage the patient’s volume status when abnormal blood pressures were identified. Findings include: 1. On 05/06/2025, the Facility’s policy titled, “Patient Assessment and Monitoring” (dated 05/01/2023) was reviewed and required, “Pre-Treatment: Record blood pressure (BP). Verify: Systolic blood pressures greater than 180 mm/Hg (milliliters per mercury/top number of blood pressure reading) and/or diastolic blood pressures greater than 100 mm/Hg (bottom number of BP) During Treatment ... Report to the nurse: Systolic blood pressures greater than 180 ... diastolic blood pressure greater than 100 ...” 2. On 05/06/2025, Pt. #4’s clinical record was reviewed. Pt. #4 was admitted on 11/24/2023, with a diagnosis of end stage renal disease (ESRD). Pt. #4’s treatment flowsheets dated 04/21/2025 through 05/05/2025 lacked documentation that the Registered Nurse (RN) was notified of diastolic blood pressures that were greater than 100 mm/Hg on the following dates/times: -04/23/2025 at 7:25 AM, 159/106, at 7:55 AM, 159/114 -04/25/2025 at 7:31 AM, 190/126, at 8:00 AM, 172/132, and at 9:00 AM, 157/103 -04/28/2025 at 7:38 AM, 167/112, at 9:02 AM, 148/104 -04/30/2025 at 7:35 AM, 166/107, at 8:01 AM, 174/117 -05/02/2025 at 8:30 AM, 149/101, at 10:02 AM, 157/120 -05/03/2025 at 7:59 AM, 147/127, at 8:33 AM, 144/106 -05/05/2025 at 7:18 AM, 149/101, at 7:28 AM, 150/110, and at 10:22 AM, 166/115 3. On 05/06/2025, Pt. #5’s clinical record was reviewed. Pt. #5 was admitted on 04/21/2025, with a diagnosis of ESRD. Pt. #5’s treatment flowsheets dated 04/21/2025 through 05/025/2025. The flowsheets dated 05/05/2025, lacked documentation that the RN [registered nurse] was notified of a systolic blood pressure greater than 180 mm/Hg at the following times: -At 6:05 AM, 211/80 and at 6:26 AM, 200/79. 4. On 05/06/2025 at 1:55 PM, an interview was conducted with the Clinical Manager (E #1). E #1 stated that abnormal blood pressures should be reported to the Registered Nurse and documented in the clinical record.”