Fmc - Lawrence County

“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: 48658 Based on record review and interview, the facility failed to maintain the physician-ordered BFR (Blood Flow Rate) for 2 of 5 in-center hemodialysis patient records reviewed (Patient #2 & #5). Findings include: 1. A policy titled “Patient Assessment and Monitoring” indicated but was not limited to: “Check prescribed blood flow is being achieved or reason is documented in the medical record if unable to meet prescribed blood flow ...” 2. The hemodialysis treatment orders for Patient #5 for 06/28/2024 through 07/06/2024 indicated a physician-ordered BFR of 400. A treatment record dated 06/27/2024 indicated a BFR of 370 30 minutes after the initiation of dialysis treatment and remained unchanged for 26 minutes; the BFR was then changed from 370 to 380 and remained unchanged for 1 hour; the BFR was then changed to the ordered rate of 400. The changes to the BFR were made without a documented reason for the change in the physician-ordered prescription. A treatment record dated 07/02/2024 indicated a BFR of 320 34 minutes after the initiation of dialysis treatment and remained unchanged for 30 minutes; the BFR was then changed from 320 to 300 and remained unchanged for the remaining duration of the treatment. 3. The hemodialysis treatment orders for Patient #2 for 06/24/2024 through 07/04/2024 indicated a Physician-ordered BFR of 400 A treatment record dated 06/24/2024 indicated a BFR change from 400 to 0, 49 minutes after the initiation of dialysis treatment. The BFR was changed from 0 to 300 after the first 1 hour and 18 minutes of initiation of dialysis treatment and remained unchanged for 56 minutes. The record failed to indicate the reason and/or intervention related to the change in the physician-ordered BFR. A treatment record dated 07/03/2024 indicated a BFR of 350 first 36 minutes after the initiation of dialysis treatment and remained unchanged for 29 minutes; the BFR was then changed from 350 to 345 and remained unchanged for 29 minutes. The record failed to indicate the reason and/or intervention related to the change in the physician-ordered BFR. 4. During an interview on 07/09/2024 at 1:25 PM, Registered Nurse (RN) 1 indicated that if a patient is not meeting a physician-ordered BFR the Patient Care Technician (PCT) is to notify the nurse, document the reason for the change in BFR, and the physician is made aware. 5. During an interview on 07/09/2024 at 1:33 PM, PCT 2 indicated that if a BFR is changed, it should be reported to the nurse and documented in Chairside (electronic medical record system). 6. During an interview on 07/09/2024 at 10:55 AM, the Administrator indicated if a patient’s BFR is changed from the ordered rate during dialysis treatment, there should be documentation specifically about why the rate was changed, in the patient record.”

“MD RESP-ENSURE ALL ADHERE TO P&P CFR(s): 494.150(c)(2)(i) The medical director must- (2) Ensure that- (i) All policies and procedures relative to patient admissions, patient care, infection control, and safety are adhered to by all individuals who treat patients in the facility, including attending physicians and nonphysician providers; This Standard is not met as evidenced by: 48658 Based on record review and interview, the facility failed to follow policy ensuring that the Registered Nurse (RN) assessment was completed prior to the start of dialysis treatment for 1 of 1 New Admission, in-center hemodialysis patient records reviewed (Patient #2). Findings include: 1. A policy titled, “Comprehensive Interdisciplinary Assessment and Plan of Care” indicated but was not limited to: “Prior to Initiation of the Patients First Treatment for Patients New to Dialysis: A registered nurse must perform an assessment on patients NEW to dialysis BEFORE initiation of their first treatment to determine immediate needs”. 2. A document titled, “Patient Transfer” for Patient #2 indicated an admission date of 03/04/2024. A treatment sheet for Patient #2, dated 03/04/2024 indicated a treatment start time of 12:37 PM with an initial assessment completed by the Registered Nurse (RN) at 1:40 PM. 3. During an interview on 07/09/2024 at 12:05 PM, the Home Area Team Lead indicated that the RN assessment for a new patient starting dialysis must be completed before the patient’s first treatment. The Administrator was present during this interview. 4. During an interview on 07/09/2024 at 1:25 PM, RN 1 indicated that for a new patient admission, the RN Assessment must be completed before the patient starts treatment. 5. During an interview on 07/10/2024 at 10:30 AM, the Administrator indicated that the issue with the RN Assessment failing to record the accurate time of completion within the Electronic Medical Record had been identified and is working to remedy this concern.”