Fmc - Dialysis of Mayfield

“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 5 (Patients #1, #2, #3, #4, and #5) 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 42 patients who received dialysis treatments at the facility. The findings include: 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 11/20/2024 revealed a prescribed blood flow rate (BFR) of 450 milliliters per minute (mL/min) and a prescribed dialysate flow rate (DFR) of 800 mL/min. Patient #1’s BFR was documented as 350 mL/min from 10:01 AM until the treatment was terminated at 1:43 PM, and the DFR was documented between 100 mL/min and 500 mL/min during the entire treatment. There was no rationale documented why the prescribed BFR and DFR were not achieved. Patient #1’s treatment sheet dated 11/24/2024 revealed a prescribed DFR of 800 mL/min. Patient #1’s DFR was documented as 700 mL/min during the entire treatment. There was no rationale documented why the prescribed DFR was not achieved. Patient #1’s treatment sheet dated 11/29/2024 revealed a prescribed DFR of 800 mL/min. Patient #1’s DFR was documented as 700 mL/min during the entire treatment. There was no rationale documented why the prescribed DFR was not achieved. 2. Patient #2’s treatment sheet dated 11/27/2024 revealed a prescribed blood flow rate (BFR) of 450 milliliters per minute (mL/min) and a prescribed dialysate flow rate (DFR) of 800 mL/min. Patient #2’s BFR was documented as 425 mL/min from 2:32 PM until 3:04 PM. There was no rationale documented why the prescribed BFR and DFR were not achieved. Patient #2’s treatment sheet dated 12/07/2024 revealed a prescribed DFR of 800 mL/min. Patient #2’s DFR was documented as 700 mL/min during the entire treatment. There was no rationale documented why the prescribed DFR was not achieved. Patient #2’s treatment sheet dated 12/10/2024 revealed a prescribed BFR of 450 mL/min. Patient #2’s BFR was documented as 260 mL/min during the entire treatment. There was no rationale documented why the prescribed BFR was not achieved. 3. Patient #3’s treatment sheet dated 11/26/2024 revealed a prescribed dialysate flow rate (DFR) of 800 mL/min. Patient #3’s DFR was documented as 700 mL/min during the entire treatment. There was no rationale documented why the prescribed DFR was not achieved. Patient #3’s treatment sheet dated 12/02/2024 revealed a prescribed blood flow rate (BFR) of 400 milliliters per minute (mL/min) and a prescribed DFR of 800 mL/min. Patient #3’s BFR was documented between 375 mL/min and 380 mL/min, and the DFR was documented as 700 mL/min the entire treatment. There was no rationale documented why the prescribed BFR and DFR were not achieved. 4. Patient #4’s treatment sheet dated 12/03/2024 revealed a prescribed dialysate flow rate (DFR) of 700 mL/min. Patient #4’s DFR was documented as 800 mL/min during the entire treatment. There was no rationale documented why the prescribed DFR was not achieved. Patient #4’s treatment sheet dated 12/07/2024 revealed a prescribed blood flow rate (BFR) of 450 milliliters per minute (mL/min). Patient #4’s BFR was documented as 400 mL/min from 7:05 AM until the treatment was terminated at 9:11 AM. There was no rationale documented why the prescribed BFR was not achieved. Patient #4’s treatment sheet dated 12/10/2024 revealed a prescribed BFR of 450 mL/min. Patient #4’s BFR was documented as 400 mL/min from 7:31 AM until the treatment was terminated at 9:01 AM. There was no rationale documented why the prescribed BFR was not achieved. 5. Patient #5’s treatment sheet dated 11/19/2024 revealed a prescribed blood flow rate (BFR) of 600 milliliters per minute (mL/min) and a prescribed dialysate flow rate (DFR) of 1.5 times the BFR (600 mL/min x 1.5 = 900 mL/min). Patient #5’s DFR was documented as 500 mL/min during the entire treatment. There was no rationale documented why the prescribed DFR was not achieved. Patient #5’s treatment sheet dated 11/21/2024 revealed a prescribed BFR of 600 mL/min. Patient #5’s BFR was documented as 565 mL/min during the entire treatment. There was no rationale documented why the prescribed BFR was not achieved. Patient #5’s treatment sheet dated 11/30/2024 revealed a prescribed BFR of 600 mL/min. Patient #5’s BFR was documented as 450 mL/min during the entire treatment. There was no rationale documented why the prescribed BFR was not achieved. During an interview on 12/17/2024 at 1:15 PM, the Clinical Manager stated, “We are supposed to” document reasons when the prescribed BFR and/or DFR were not achieved. During an interview on 12/18/2024 at 9:55 AM, Certified Clinical Hemodialysis Technician #4 stated she was expected to document the reason when the prescribed BFR and/or DFR were not achieved. During an interview on 12/18/2024 at 10:05 AM, Registered Nurse #3 stated she was expected to document a rationale when the prescribed BFR and/or DFR were not achieved. During an interview on 12/18/2024 at 11:17 AM, the Medical Director stated documentation was “very important,” and staff were expected to document reasons for changes to the prescribed BFR and/or DFR.”

“POC-MANAGE VOLUME STATUS CFR(s): 494.90(a)(1) The plan of care must address, but not be limited to, the following: (1) Dose of dialysis. The interdisciplinary team must provide the necessary care and services to manage the patient’s volume status; This Standard is not met as evidenced by: 35949 Based on interview, record review, and facility policy review, the facility failed to monitor patients’ vital signs and/or machine parameters according to the expectations in their policy for 5 (Patients #1, #2, #3, #4, and #5) of 5 sampled patients. Failure to monitor patients’ vitals and/or machine parameters according to the facility’s policy provided an opportunity for changes to the patients’ condition during dialysis treatments to be unrecognized and unaddressed and negatively impact the care provided to the 42 patients who received dialysis treatments at the facility. The findings include: A facility policy titled, “Patient Assessment and Monitoring,” published 05/01/2023, indicated, “During Treatment * Obtain blood pressure and pulse rate every 30 minutes or more as needed but not to exceed 45 minutes or per state regulations. * Document machine parameters and safety checks every 30 minutes or more often as needed but not to exceed 45 minutes or per state regulations.” 1. Patient #1’s treatment sheet, dated 11/20/2024, revealed monitoring was not documented for 152 minutes, from 10:01 AM until 12:33 PM. Patient #1’s treatment sheet, dated 11/22/2024, revealed monitoring was not documented for 66 minutes, from 11:04 AM until 12:10 PM. Patient #1’s treatment sheet, dated 11/24/2024, revealed monitoring was not documented for 63 minutes, from 10:03 AM until 12:06 PM. 2. Patient #2’s treatment sheet, dated 11/30/2024, revealed monitoring was not documented for 66 minutes, from 10:31 AM until 11:37 AM and for 61 minutes from 12:31 PM until 1:32 PM. Patient #2’s treatment sheet, dated 12/07/2024, revealed monitoring was not documented for 59 minutes, from 10:38 AM until 11:37 AM. Patient #2’s treatment sheet, dated 12/10/2024, revealed monitoring was not documented for 69 minutes, from 12:32 PM until 1:41 PM. Patient #2’s treatment sheet, dated 12/12/2024, revealed monitoring was not documented for 59 minutes, from 10:38 AM until 11:37 AM and for 93 minutes from 12:37 PM until the treatment was terminated at 2:10 PM. Patient #2’s treatment sheet, dated 12/14/2024, revealed monitoring was not documented for 52 minutes, from 11:09 AM until 12:01 PM and for 59 minutes from 1:04 PM until 2:03 PM. 3. Patient #3’s treatment sheet, dated 11/29/2024, revealed monitoring was not documented for 63 minutes, from 12:02 PM until 1:05 PM. Patient #3’s treatment sheet, dated 12/02/2024, revealed monitoring was not documented for 66 minutes, from 1:30 PM until 2:36 PM. Patient #3’s treatment sheet, dated 12/04/2024, revealed monitoring for vitals was not documented for 61 minutes, from 11:27 AM until 12:38 PM and for machine parameters for 51 minutes, from 11:47 AM until 12:38 PM. Patient #3’s treatment sheet, dated 12/06/2024, revealed monitoring for vitals was not documented for 60 minutes, from 1:03 PM until 2:03 PM, for machine parameters for 53 minutes from 1:03 PM until 1:56 PM, and for both vitals and machine parameters for 50 minutes from 2:03 PM until the treatment was terminated at 2:53 PM. Patient #3’s treatment sheet, dated 12/13/2024, revealed monitoring was not documented for 51 minutes, from 11:48 AM until 12:39 PM and for another 51 minutes from 2:08 PM until 2:59 PM. 4. Patient #4’s treatment sheet, dated 11/30/2024, revealed monitoring was not documented for 48 minutes, from 8:04 AM until 8:52 AM. Patient #4’s treatment sheet, dated 12/05/2024, revealed monitoring was not documented for 48 minutes, from 6:14 AM until 7:02 AM. Patient #4’s treatment sheet, dated 12/12/2024, revealed monitoring was not documented for 48 minutes, from 6:26 AM until 7:14 AM and for 57 minutes from 7:40 AM until 8:37 AM. Patient #4’s treatment sheet, dated 12/14/2024, revealed monitoring was not documented for 70 minutes, from 8:08 AM until the treatment was terminated at 9:18 AM. 5. Patient #5’s treatment sheet, dated 11/30/2024, revealed monitoring was not documented for 60 minutes, from 8:05 AM until 9:05 AM. Patient #5’s treatment sheet, dated 12/11/2024, revealed monitoring was not documented for 52 minutes, from 8:31 AM until 9:23 AM. During an interview on 12/17/2024 at 1:30 PM, the Clinical Manager stated documentation of patient monitoring was expected “every half hour.” During an interview on 12/18/2024 at 9:55 AM, Certified Clinical Hemodialysis Technician #4 stated she was expected to document patient monitoring “every 30 minutes.” During an interview on 12/18/2024 at 10:05 AM, Registered Nurse #3 stated she was expected to document patient monitoring every 30 minutes. During an interview on 12/18/2024 at 11:17 AM, the Medical Director confirmed documentation of patient monitoring was expected “every 30 minutes or more [frequently].””