Davita Nottingham 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 3 (Registered Nurse (RN) 3, Certified Clinical Hemodialysis Technicians [CCHT] 4, and 5) of 4 observed staff performed hand hygiene before they touched patient care supplies, before they touched patient care equipment (dialysis machine, blood pressure cuff), and after they removed their gloves. 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 22 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 10/30/24 with the Facility Administrator and the Manager of Clinical Services revealed the following: At 8:55 AM, CCHT 4 obtained and applied a face mask while holding a pair of gloves in her left hand. CCHT 4 applied the held pair of gloves, entered Station 2, and touched the patient care supplies on the chairside table. At 9:07 AM, RN 3 disinfected Station 6 while wearing a pair of gloves. RN 3 pushed a biohazard bin from the station with her gloved hand, and then touched the dialysis machine. At 9:29 AM, CCHT 5 typed on a computer keyboard near Station 10. CCHT 5 obtained and applied a pair of gloves, entered Station 10, and touched the dialysis machine. At 9:42 AM, CCHT 5 obtained and applied a previously used face shield. CCHT 5 obtained and applied a pair of gloves, entered Station 9, and touched the dialysis machine. At 9:54 AM, RN 3 obtained and applied a previously used face shield. RN 3 obtained and applied a pair of gloves, entered Station 11, and touched the blood pressure cuff. At 10:35 AM, CCHT 5 was observed in Station 11 while wearing a pair of gloves. CCHT 5 exited the station, removed the pair of gloves, and typed on a computer keyboard near Station 11. During an interview on 10/30/24 at 9:11 AM, RN 3 confirmed she was trained and expected to perform hand hygiene before she touched patient care equipment. During an interview on 10/30/24 at 9:50 AM, CCHT 5 confirmed he was trained and expected to perform hand hygiene before he touched patient care equipment and after he removed gloves. During an interview on 11/01/24 at 9:50 AM, the Medical Director stated the staff were expected to “always clean their hands.” During an interview on 11/01/24 at 10:14 AM, the Facility Administrator confirmed staff were trained and expected to perform hand hygiene before they touched patient care supplies, patient care equipment, and after they removed their gloves.”

“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 and medication prescription as prescribed by the medical provider for 4 (Patients 1, 2, 3 and 5) of 5 sampled patients. Failure to follow the medical providers’ dialysis and medication prescription had the potential to negatively impact the effectiveness of the prescribed dialysis treatments and prescribed medications for the 22 patients who received dialysis treatments at the facility. Findings Include: A facility policy titled, “Anticoagulation,” revised 09/2024, indicated, “15. A heparin pump is used to deliver a constant infusion of heparin over the course of the hemodialysis treatment in order to avoid heparin fluctuations that occur with intermittent injections. 16. It is recommended that the heparin hourly infusion be discontinued 60 minutes prior to the end of treatment for patients with arterio-venous (AV) fistulas and/or AV grafts per physician/NPP [non-physician practitioner] order. It is recommended that the heparin hourly infusion be continued for the entire treatment for patients with CVCs [central venous catheters].” A facility policy titled, “Physician Orders for Patient Care,” revised 10/2024, indicated, “Purpose: To verify that orders are properly documented, transcribed, verified and implemented in a timely manner for patient care in [name] facilities and hospital programs which meet all [name], federal and applicable state regulations.” 1. Review of Patient 1’s “Treatment Details Report,” dated 10/11/24, revealed a prescribed blood flow rate (BFR) of 400 milliliters per minute (mL/min). Patient 1’s BFR was documented as 350 mL/min from 11:03 AM until the treatment was terminated at 12:03 PM. There was no rationale documented why the prescribed BFR was not achieved. 2. Review of Patient 2’s “Treatment Details Report,” dated 10/11/24, revealed a prescribed blood flow rate (BFR) of 450 milliliters per minute (mL/min). Patient 2’s BFR was documented as 415 mL/min from 12:03 PM until the treatment was terminated at 12:29 PM. There was no rationale documented why the prescribed BFR was not achieved. Review of Patient 2’s “Treatment Details Report,” dated 10/14/24, revealed a prescribed BFR of 450 mL/min. Patient 2’s BFR was documented as 400 mL/min from 10:32 AM until the treatment was terminated at 12:32 PM. There was no rationale documented why the prescribed BFR was not achieved. Review of Patient 2’s “Treatment Details Report,” dated 10/23/24, revealed a prescribed BFR of 450 mL/min. Patient #2’s BFR was documented as 405 mL/min from 12:03 PM until the treatment was terminated at 12:28 PM. There was no rationale documented why the prescribed BFR was not achieved. 3. Review of Patient 3’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” indicated the heparin pump was still engaged at 12:50 PM when the treatment was terminated. Review of Patient 3’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” indicated the heparin pump was still engaged at 12:55 PM when the treatment was terminated. Review of Patient 3’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” indicated the heparin pump was still engaged at 1:05 PM when the treatment was terminated. Review of Patient 3’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” indicated the heparin pump was still engaged at 1:03 PM when the treatment was terminated. Review of Patient 3’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” indicated the heparin pump was still engaged at 1:11 PM when the treatment was terminated. Review of Patient 3’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” indicated the heparin pump was still engaged at 1:03 PM when the treatment was terminated. Review of Patient 3’s “Treatment Details Report,” dated 10/23/24, revealed a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. The “Intradialytic Vitals Stat Line” indicated the heparin pump was still engaged at 12:37 PM when the treatment was terminated. Review of Patient 3’s “Treatment Details Report,” dated 10/25/24, revealed a prescribed blood flow rate (BFR) of 450 milliliters per minute (mL/min) and a prescribed hourly infusion of heparin to be stopped 60 minutes before the end of the treatment. Patient 3’s BFR was documented as 440 mL/min from 10:03 AM until the treatment was terminated at 12:24 PM. The “Intradialytic Vitals Stat Line” indicated the heparin pump was still engaged at 12:24 PM when the treatment was terminated. There was no rationale documented why the prescribed BFR was not achieved. 4. Review of Patient 5’s “Treatment Details Report,” dated 10/09/24, revealed a prescribed blood flow rate (BFR) of 450 milliliters per minute (mL/min). Patient #5’s BFR was documented as 350 mL/min from 7:33 AM until the treatment was terminated at 8:55 AM. There was no rationale documented why the prescribed BFR was not achieved. Review of Patient 5’s “Treatment Details Report,” dated 10/19/24, revealed a prescribed BFR of 450 mL/min. Patient #5’s BFR was documented as 400 mL/min from 11:33 AM until the treatment was terminated at 1:58 PM. There was no rationale documented why the prescribed BFR was not achieved. Review of Patient 5’s “Treatment Details Report,” dated 10/23/24, revealed a prescribed BFR of 450 mL/min. Patient 5’s BFR was documented as 400 mL/min from 6:07 AM until 8:33 AM. There was no rationale documented why the prescribed BFR was not achieved. During an interview on 11/01/24 at 9:50 AM, the Medical Director confirmed staff were expected to document “why” changes were made to the physicians’ orders. During an interview on 11/01/24 at 10:14 AM, the Facility Administrator confirmed staff were trained and expected to document reasons for changes to the physicians’ orders. During an interview on 11/01/24 at 10:32 AM, Registered Nurse 3 confirmed staff were trained and expected to document reasons for changes to the physicians’ orders. During an interview on 11/01/24 at 10:52 AM, Certified Clinical Hemodialysis Technician 5 confirmed staff were trained and expected to document reasons for changes to the physicians’ orders.”