Davita Gardner Dialysis

“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: 35949 Based on observation, interview, and facility policy review, the facility failed to ensure 2 (Certified Clinical Hemodialysis Technician [CCHT] 5 and CCHT 6) of 2 observed staff performed hand hygiene before they touched patient care equipment (dialysis machine). Failure to perform hand hygiene provided a mode of cross contamination with the potential spread of pathogens, which could negatively impact the health and well-being of the 39 patients who received dialysis treatments at the facility. Findings Include: A facility policy titled, “Infection Control for Dialysis Facilities,” revised 04/2023, indicated, “Hand Hygiene 1. All teammates, Physicians and Non-Physician (NPP) will perform hand hygiene a. upon entering and exiting the treatment area, b. prior to gloving and immediately after glove removal, c. after contamination with blood or other infectious material, d. after patient and dialysis delivery system contact, e. after interacting with wall boxes (i.e., plugging/unplugging acid/bicarb lines form [sic] dialysis machine, changing acid types, when exchanging a dialysis machine), f. between patients even if the contact is casual, g. before touching clean areas such as supplies, supply cart and chairside keyboard/mouse.” Observations of the dialysis treatment area on 10/22/24 revealed the following: At 9:17 AM, CCHT 5 was observed opening supply storage drawers while holding a pair of gloves in her left hand. CCHT 5 applied the held pair of gloves, entered Station 6, and touched the dialysis machine. At 9:18 AM, CCHT 5 was observed typing on a computer keyboard near Station 6. CCHT 5 obtained and applied a pair of gloves, entered Station 6, and touched the dialysis machine. At 9:21 AM, CCHT 6 was observed typing on a computer keyboard near Station 7. CCHT 6 obtained and applied a pair of gloves, entered Station 7, and touched the dialysis machine. During an interview on 10/22/24 at 9:26 AM, CCHT 5 stated she was sure she was trained and expected to perform hand hygiene before she touched patient care equipment. During an interview on 10/22/24 at 9:27 AM, CCHT 6 acknowledged she was trained and expected to perform hand hygiene before she touched patient care equipment. During an interview on 10/23/24 at 2:45 PM, the Medical Director confirmed staff should perform hand hygiene before they touched patient care equipment. During an interview on 10/24/24 at 8:30 AM, the Facility Administrator confirmed staff were trained and expected to perform hand hygiene before they touched patient care equipment.”

“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: 35949 Based on interview, record review, and facility policy review, the facility failed to follow the individualized dialysis prescription as prescribed by the medical provider for 2 (Patient 3 and Patient 4) of 5 sampled patients. Failure to follow the medical providers’ dialysis prescription had the potential to negatively impact the effectiveness of the prescribed dialysis treatments for the 39 patients who received dialysis treatments at the facility. Findings Include: A facility policy titled, “Anticoagulation,” revised 09/2024, revealed “Use of Heparin: 3. Heparin is administered per physician/Non-Physician Practitioner (NPP) order.” 1. Review of Patient 3’s “Treatment Details Report,” dated 10/01/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 9:02 AM, 42 minutes before the treatment termination at 9:44 AM. Review of Patient 3’s “Treatment Details Report,” dated 10/03/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 9:02 AM, 45 minutes before the treatment termination at 9:47 AM. Review of Patient 3’s “Treatment Details Report,” dated 10/05/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 9:03 AM, 44 minutes before the treatment termination at 9:47 AM. Review of Patient 3’s “Treatment Details Report,” dated 10/08/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 9:47 AM, three minutes after the treatment termination at 9:44 AM. Review of Patient 3’s “Treatment Details Report,” dated 10/10/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 9:02 AM, 44 minutes before the treatment termination at 9:46 AM. Review of Patient 3’s “Treatment Details Report,” dated 10/12/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 9:03 AM, 43 minutes before the treatment termination at 9:46 AM. Review of Patient 3’s “Treatment Details Report,” dated 10/15/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 9:03 AM, 48 minutes before the treatment termination at 9:51 AM. Review of Patient 3’s “Treatment Details Report,” dated 10/17/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 9:03 AM, 41 minutes before the treatment termination at 9:44 AM. 2. Review of Patient 4’s “Treatment Details Report,” dated 10/02/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 12:31 PM, 38 minutes before the treatment termination at 1:09 PM. Review of Patient 4’s “Treatment Details Report,” dated 10/07/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 12:31 PM, 34 minutes before the treatment termination at 1:05 PM. Review of Patient 4’s “Treatment Details Report,” dated 10/09/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 12:31 PM, 51 minutes before the treatment termination at 1:22 PM. Review of Patient 4’s “Treatment Details Report,” dated 10/11/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 12:31 PM, 40 minutes before the treatment termination at 1:11 PM. Review of Patient 4’s “Treatment Details Report,” dated 10/14/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 1:24 PM, the same time as the treatment termination at 1:24 PM. Review of Patient 4’s “Treatment Details Report,” dated 10/16/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 12:31 PM, 35 minutes before the treatment termination at 1:06 PM. Review of Patient 4’s “Treatment Details Report,” dated 10/18/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 12:31 PM, 39 minutes before the treatment termination at 1:10 PM. Review of Patient 4’s “Treatment Details Report,” dated 10/21/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” revealed a heparin pump stop time of 12:31 PM, 35 minutes before the treatment termination at 1:06 PM. During an interview on 10/23/24 at 2:45 PM, the Medical Director confirmed staff were expected to follow physicians’ orders. During an interview on 10/23/24 at 5:06 PM, Registered Nurse (RN) 4 confirmed staff were trained and expected to follow physicians’ orders. During an interview on 10/24/24 at 8:30 AM, the Facility Administrator confirmed the staff were trained and expected to follow physicians’ orders.”