Fkc - Belleville

“POC-ACHIEVE ADEQUATE CLEARANCE CFR(s): 494.90(a)(1) Achieve and sustain the prescribed dose of dialysis to meet a hemodialysis Kt/V of at least 1.2 and a peritoneal dialysis weekly Kt/V of at least 1.7 or meet an alternative equivalent professionally-accepted clinical practice standard for adequacy of dialysis. This Standard is not met as evidenced by: 39025 Based on document review and staff interview, it was determined for 3 of 7 (Pt #3, Pt #6 and Pt #7) patient’s records reviewed for BFR (Blood Flow Rate) and DFR (Dialysis Flow Rate), the ESRD (End Stage Renal Disease) Facility failed to ensure the patient’s BFR and DFR was achieved and maintained in accordance with the dialysis prescription. Findings include: 1. On 12/18/24, Pt #3’s record was reviewed. Pt #3 was admitted for in-center hemodialysis on 10/22/24 with a diagnosis of ESRD. Pt #3’s clinical record contained a revised physician order dated 11/12/24 that noted a BFR of 450 and a DFR of 800. Pt #3’s treatment sheets dated 11/21, 11/23, 11/25, 11/30, 12/03, 12/05, 12/07, 12/10, 12/12, and 12/14 failed to achieve the prescribed BFR of 450. Pt #3’s treatment sheets dated 11/21, 11/23, 11/30, and 12/10 failed to achieve the prescribed DFR of 800. The record lacked documentation as to why the prescribed BFR and DFR was not met. 2. On 12/18/24, Pt #6’s record was reviewed. Pt #6 was admitted for in-center hemodialysis on 02/22/23 with a diagnosis of ESRD. Pt #6’s clinical record contained a physician order dated 08/26/24 that noted a BFR of 350 and a DFR of 800. Pt #6’s treatment sheets dated 11/20, 11/22, 11/24, 11/26, 11/29, 12/02, 12/04, 12/06, 12/07, 12/09, 12/11, 12/13, 12/16, and 12/18 failed to achieve the prescribed BFR of 350. Pt #6’s treatment sheets dated 11/20, 11/24, 11/29, 12/09, and 12/13 failed to achieve the prescribed DFR of 800. The record lacked documentation as to why the prescribed BFR and DFR was not met. 3. On 12/18/24, Pt #7’s record was reviewed. Pt #7 was admitted for in-center dialysis on 05/23/24 with a diagnosis of ESRD. Pt #7’s clinical record contained a physician order dated 11/14/24 that noted the BFR of 450 and a DFR of 800. Pt #7’s treatment sheets dated 11/21, 11/25, 11/27, 12/03, 12/12, and 12/14 failed to achieve the prescribed BFR of 450. Pt #7’s treatment sheets dated 11/25, and 12/12 failed to achieve the prescribed DFR of 800. The record lacked documentation as to why the prescribed dialysate flow was not ran. 4. On 12/19/24 the policy titled “Patient Assessment and Monitoring” (Published 05/01/23) was reviewed. The policy noted, “Purpose ... to provide guidance to (facility name) direct patient care staff on assessment and monitoring patients before, during, and after treatment. Responsibility: Direct patient care staff (RN (Registered Nurse), ..., PCT (Patient Care technician)) ... Data Collection: ... If the PCT ... note any changes or abnormal findings in the patient’s condition or vascular access are observed or reported by the patient, ... the registered nurse must assess the patient. The RN will notify the patient’s physician ... of any abnormal findings ... 3. Machine parameters and Extracorporeal Circuit: Check machine settings and measurements: Check prescribed blood flow is being achieved or reason documented in medical record if unable to meet prescribed blood flow. Check dialysate flow rate setting is correct, and the prescribed flow is being delivered. ... 4. Document any findings and interventions in the medical record.” 5. On 12/18/24 at approximately 1:15 PM, an interview with the Facility Administrator (E #1) was conducted. E #1 reviewed Pt #3, Pt #6 and Pt #7’s treatment records and verbally agreed the BFR and DFR was not achieved and there was no documentation in the records indicating why.”