Davita Calumet City 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: 32741 Based on document review, observation and interview, it was determined that for 1 of 2 Patient Care Technicians - PCT ( E #2), the Facility failed to ensure that staff demonstrated knowledge of the Facility’s infection control practices for the disinfection of CVC (central venous catheter - used for dialysis access) insertion site for initiation of the dialysis treatment, as required. Findings include: 1. On 12/4/2023, the Facility’s policy titled, “Central Venous Catheter (CVC) with Clearguard HD Antimicrobial end caps procedure” (dated 4/2023) was reviewed and indicated, “...Perform a 15 second hub scrub of the CVC during the process of connecting or disconnecting from the blood lines...” 2. On 12/4/2023 between 8:55 AM to 11:00 AM, an observational tour of the dialysis treatment area was conducted. At approximately 10:30 AM, a Patient Care Technician (E #2) was observed disinfecting CVC hubs prior to connection at station #6. E #2 disinfected the CVC hubs with 70 % alcohol for 6 seconds instead of 15 seconds, as required. 3. On 12/4/2023 at 11:10 AM, an interview was conducted with E #2. E #2 stated that CVC hubs should be disinfected for 15 seconds.”

“PE-HD PTS IN VIEW DURING TREATMENTS CFR(s): 494.60(c)(4) Patients must be in view of staff during hemodialysis treatment to ensure patient safety, (video surveillance will not meet this requirement). This Standard is not met as evidenced by: 32741 Based on document review, observation and interview, it was determined that for 1 of 10 Patients’ (Pt #8)) vascular access sites observed, the Facility failed to ensure that the vascular access site was in view at all times during dialysis treatment. Findings include: 1. On 12/4/2023, the Facility’s policy titled, “CWOW - Pre-Intra-Post Treatment Data Collection, Monitoring and Nursing Assessment “ (dated 4/2021) was reviewed and indicated, “Intradialytic Data Collection/Assessment - the vascular access site, blood line connections and the patient’s face should be visible throughout the dialysis treatment...” 2. On 12/4/2023 between 8:55 AM and 11:00AM, an observational tour of the hemodialysis treatment area was conducted. Between 8:55 AM and 9:50 AM, Pt #8’s CVC vascular access site was covered with a blanket and not in view. 3. On 12/4/2023 at 11:05 AM, an interview was conducted with the Patient Care Technician (E #3). E #3 stated that a patient’s access site should remain visible at all times to ensure access lines are connected.”

“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: 32741 Based on document review and interview, it was determined that for 1 of 7 (Pt. #3) patients receiving heparin (anticoagulation/blood thinner), the Facility failed to administer heparin as ordered, to ensure the appropriateness of the dialysis prescription. Findings include: 1. On 12/4/2023, the Facility’s policy titled, “Anticoagulation” (dated October 23, 2023)” was reviewed and required, “Use of Heparin - Heparin is administered per physician’s order. Order is to include date, time, patient name, route, frequency and as applicable: stop/discontinuation time...” 2. On 12/5/2023, Pt #3’s treatment records dated 11/18/2023 thru 11/30/2023 were reviewed. Pt. # 3 was admitted on 1/22/2018 with the diagnosis of end stage renal disease (ESRD). A physician’s order (dated 10/14/2023) included, “Heparin 600 units per hour [continuous]”, for a 210 minute treatment three times a week. Frequency - every dialysis treatment. Stop time 60 minutes before end of dialysis. -The treatment sheet, dated 11/18/2023, indicated that the heparin was started at 6:54 AM (start of treatment) and heparin was discontinued at 7:54 AM. The treatment ended at 10:27 AM (heparin not given from 7:54 AM to 10:27 AM). There was no documentation in Pt #3’s clinical record regarding why heparin was stopped approximately 2 1/2 hours earlier than ordered. -The treatment sheet, dated 11/25/2023, indicated that the heparin continued to the end of the treatment (heparin not stopped 60 minutes before end of dialysis, as ordered). There was no documentation in Pt #3’s clinical record regarding the reason for not stopping heparin as ordered. 3. On 12/5/2023 at 11:00 AM, an interview was conducted with the Facility Administrator (E #1). E #1 stated that the physician order for Heparin should be followed.”