Fmc - Hazard

“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 4 (Patients #1, #2, #3, and #4) of 4 sampled in-center patients. Findings included: A facility policy titled, “Physician Order Documentation,” published 07/03/2023, indicated, “Nurse practice acts require nurses to carry out treatment care, medication administration, lab tests, procedures, and other treatments, based on physician orders.” 1. Patient #1’s treatment sheet dated 03/11/2025 revealed a prescribed blood flow rate (BFR) of 350 milliliters per minute (mL/min). The treatment sheet revealed Patient #1’s BFR was documented as 450 mL/min during the entire treatment. The treatment sheet revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #1’s treatment sheet dated 03/18/2025 revealed a prescribed BFR of 350 mL/min. The treatment sheet revealed Patient #1’s BFR was documented as 425 mL/min during the entire treatment. The treatment sheet revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #1’s treatment sheet dated 03/25/2025 revealed a prescribed BFR of 350 mL/min. The treatment sheet revealed Patient #1’s BFR was documented as 300 mL/min during the entire treatment. The treatment sheet revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #1’s treatment sheet dated 03/27/2025 revealed a prescribed BFR of 350 mL/min. The treatment sheet revealed Patient #1’s BFR was documented as 300 mL/min during the entire treatment. The treatment sheet revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #1’s treatment sheet dated 03/29/2025 revealed a prescribed BFR of 350 mL/min. The treatment sheet revealed Patient #1’s BFR was documented as 300 mL/min during the entire treatment. The treatment sheet revealed there was no rationale documented as to why the prescribed BFR was not achieved. 2. Patient #2’s treatment sheet dated 03/19/2025 revealed a prescribed blood flow rate (BFR) of 400 milliliters per minute (mL/min) and a prescribed dialysate flow rate (DFR) of 1.5 times the achieved BFR (600 mL/min). The treatment sheet revealed Patient #2’s BFR was documented as 300 mL/min and the DFR was documented at 500 mL/min during the entire treatment. The treatment sheet revealed there was no rationale documented as to why the prescribed BFR and DFR were not achieved. Patient #2’s treatment sheet dated 03/28/2025 revealed a prescribed BFR of 400 mL/min. the treatment sheet revealed Patient #2’s BFR was documented as 350 mL/min from 9:02 AM until the treatment was terminated at 10:14 AM. The treatment sheet revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #2’s treatment sheet dated 03/31/2025 revealed a prescribed BFR of 400 mL/min and a prescribed DFR of 1.5 times the achieved BFR (600 mL/min). The treatment sheet revealed Patient #2’s DFR was documented as 800 mL/min from 8:56 AM until the treatment was terminated at 10:01 AM, and the BFR was documented as 300 mL/min from 9:22 AM until the treatment was terminated at 10:01 AM. The treatment sheet revealed there was no rationale documented as to why the prescribed BFR and DFR were not achieved. 3. Patient #3’s treatment sheet dated 03/12/2025 revealed a prescribed blood flow rate (BFR) of 350 milliliters per minute (mL/min). The treatment sheet revealed Patient #3’s BFR was documented as 300 mL/min during the entire treatment. The treatment sheet revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #3’s treatment sheet dated 03/14/2025 revealed a prescribed BFR of 350 mL/min. The treatment sheet revealed Patient #3’s BFR was documented as 300 mL/min from 8:20 AM until the treatment was terminated at 10:59 AM. The treatment sheet revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #3’s treatment sheet dated 03/24/2025 revealed a prescribed BFR of 350 mL/min. The treatment sheet revealed Patient #3’s BFR was documented as 300 mL/min from 8:26 AM until the treatment was terminated at 10:10 AM. The treatment sheet revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #3’s treatment sheet dated 03/26/2025 revealed a prescribed BFR of 350 mL/min. The treatment sheet revealed Patient #3’s BFR was documented as 300 mL/min from 9:00 AM until the treatment was terminated at 10:16 AM. The treatment sheet revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #3’s treatment sheet dated 03/31/2025 revealed a prescribed BFR of 350 mL/min. The treatment sheet revealed Patient #3’s BFR was documented as 300 mL/min from 9:22 AM until the treatment was terminated at 10:24 AM. The treatment sheet revealed there was no rationale documented as to why the prescribed BFR was not achieved. 4. Patient #4’s treatment sheet dated 03/12/2025 revealed a prescribed blood flow rate (BFR) of 400 milliliters per minute (mL/min) and a prescribed dialysate flow rate (DFR) of 1.5 times the achieved BFR (600 mL/min). The treatment sheet revealed Patient #4’s BFR was documented as 400 mL/min and the DFR was documented as 700 mL/min from 6:52 AM until 7:55 AM and again from 8:26 AM until the treatment was terminated at 10:51 AM. The treatment sheet revealed there was no rationale documented as to why the prescribed DFR was not achieved. Patient #4’s treatment sheet dated 03/14/2025 revealed a prescribed BFR of 400 mL/min and a prescribed DFR of 1.5 times the achieved BFR (600 mL/min). The treatment sheet revealed Patient #4’s BFR was documented as 400 mL/min and the DFR was documented as 700 mL/min from 6:53 AM until 7:57 AM, and the BFR was documented as 375 mL/min from 7:57 AM until the treatment was terminated at 10:44 AM. The treatment sheet revealed there was no rationale documented as to why the prescribed DFR and BFR were not achieved. Patient #4’s treatment sheet dated 03/19/2025 revealed a prescribed BFR of 400 mL/min and a prescribed DFR of 1.5 times the achieved BFR (600 mL/min). The treatment sheet revealed Patient #4’s BFR was documented as 400 mL/min and the DFR was documented as 700 mL/min during the entire treatment. The treatment sheet revealed there was no rationale documented as to why the prescribed DFR was not achieved. Patient #4’s treatment sheet dated 03/21/2025 revealed a prescribed BFR of 400 mL/min and a prescribed DFR of 1.5 times the achieved BFR (600 mL/min). The treatment sheet revealed Patient #4’s BFR was documented as 400 mL/min and the DFR was documented as 700 mL/min from 6:52 AM until 7:28 AM. The treatment sheet revealed there was no rationale documented as to why the prescribed DFR was not achieved. Patient #4’s treatment sheet dated 03/24/2025 revealed a prescribed BFR of 400 mL/min and a prescribed DFR of 1.5 times the achieved BFR (600 mL/min). The treatment sheet revealed Patient #4’s BFR was documented as 400 mL/min and the DFR was documented as 700 mL/min during the entire treatment. The treatment sheet revealed there was no rationale documented as to why the prescribed DFR was not achieved. Patient #4’s treatment sheet dated 03/26/2025 revealed a prescribed BFR of 400 mL/min and a prescribed DFR of 1.5 times the achieved BFR (600 mL/min). The treatment sheet revealed Patient #4’s BFR was documented as 400 mL/min and the DFR was documented as 700 mL/min from 6:50 AM until the treatment was terminated at 10:35 AM. The treatment sheet revealed there was no rationale documented as to why the prescribed DFR was not achieved. Patient #4’s treatment sheet dated 03/31/2025 revealed a prescribed BFR of 400 mL/min and a prescribed DFR of 1.5 times the achieved BFR (600 mL/min). The treatment sheet revealed Patient #4’s BFR was documented as 400 mL/min and the DFR was documented as 700 mL/min from 7:23 AM until the treatment was terminated at 11:46 AM. The treatment sheet revealed there was no rationale documented as to why the prescribed DFR was not achieved. During an interview on 04/02/2025 at 11:50 AM, the Interim Clinical Manager confirmed staff were trained and expected to document a reason for why the prescribed BFRs and/or DFRs were not achieved. During an interview on 04/02/2025 at 12:07 PM, Registered Nurse (RN) #14 stated she was trained and expected to “chart why” the prescribed BFRs and/or DFRs were not achieved. During an interview on 04/02/2025 at 12:15 PM, Certified Clinical Hemodialysis Technician (CCHT) #9 confirmed she was trained and expected to “tell the nurses” why the prescribed BFRs and/or DFRs were not achieved, and the staff were obligated to document a reason why they were not achieved. During an interview on 04/02/2025 at 12:43 PM, the Medical Director stated the staff “have to document” when the prescribed BFRs and/or DFRs were not achieved.”