Fmc- Lexington South Dialysis

“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 treatment as prescribed by the medical provider for 7 of 7 sampled patients, Patient (P) 1, P2, P3, P4, P5, P6, and P7. Failure to follow the medical providers’ dialysis treatment had the potential to negatively impact the effectiveness of the prescribed dialysis treatment for the 60 patients who received dialysis treatments at the facility. The findings include: Review of the facility’s policy titled, “Patient Assessment and Monitoring,” published 05/01/2023, indicated, “3. Machine Parameters and Extracorporeal Circuit: Check machine settings and measurements: *Check prescribed blood flow is being achieved or reason is documented in medical record if unable to meet prescribed blood flow [rate], *Check dialysate flow rate setting is correct, and the prescribed flow [rate] is being delivered.” 1. Review of P1’s treatment sheet, dated 08/02/2025, revealed a prescribed blood flow rate (BFR) of 400 milliliters per minute (mL/min). The treatment sheet revealed P1’s BFR was documented as 450 mL/min during the entire treatment. Further review revealed there was no rationale documented as to why the prescribed BFR was not achieved. Review of P1’s treatment sheet, dated 08/05/2025, revealed a prescribed BFR of 400 mL/min. The treatment sheet revealed P1’s BFR was documented as 450 mL/min from 1:05 PM until the treatment was terminated at 4:20 PM. Further review revealed there was no rationale documented as to why the prescribed BFR was not achieved. 2. Review of P2’s treatment sheet, dated 08/01/2025, revealed a prescribed dialysate flow rate (DFR) of 600 milliliters per minute (mL/min). The treatment sheet revealed P2’s DFR was documented as 800 mL/min during the entire treatment. Further review revealed there was no rationale documented as to why the prescribed DFR was not achieved. 3. Review of P3’s treatment sheet, dated 07/28/2025, revealed a prescribed blood flow rate (BFR) of 450 milliliters per minute (mL/min). The treatment sheet revealed P3’s BFR was documented between 400 mL/min and 415 mL/min from 1:34 PM until the treatment was terminated at 4:01 PM. Further review revealed there was no rationale documented as to why the prescribed BFR was not achieved. Review of P3’s treatment sheet, dated 08/01/2025, revealed a prescribed BFR of 450 mL/min. The treatment sheet revealed P3’s BFR was documented between 300 mL/min and 380 mL/min from 1:02 PM until the treatment was terminated at 4:14 PM. Further review revealed there was no rationale documented as to why the prescribed BFR was not achieved. Review of P3’s treatment sheet, dated 08/04/2025, revealed a prescribed BFR of 450 mL/min. The treatment sheet revealed P3’s BFR was documented between 350 mL/min and 380 mL/min from 1:33 PM until the treatment was terminated at 4:21 PM. Further review revealed there was no rationale documented as to why the prescribed BFR was not achieved. Review of P3’s treatment sheet, dated 08/11/2025, revealed a prescribed BFR of 450 mL/min. The treatment sheet revealed P3’s BFR was documented as 400 mL/min during the entire treatment. Further review revealed there was no rationale documented as to why the prescribed BFR was not achieved. 4. Review of P4’s treatment sheet, dated 08/06/2025, revealed a prescribed blood flow rate (BFR) of 400 milliliters per minute (mL/min). The treatment sheet revealed P4’s BFR was documented as 350 mL/min from 6:32 AM until the treatment was terminated at 8:45 AM. Further review revealed there was no rationale documented as to why the prescribed BFR was not achieved. Review of P4’s treatment sheet, dated 08/08/2025, revealed a prescribed BFR of 400 mL/min. The treatment sheet revealed P4’s BFR was documented between 300 mL/min and 355 mL/min from 6:10 AM until 7:28 AM and 380 mL/min from 8:17 AM until the treatment was terminated at 9:14 AM. Further review revealed there was no rationale documented as to why the prescribed BFR was not achieved. Review of P4’s treatment sheet, dated 08/11/2025, revealed a prescribed BFR of 400 mL/min. The treatment sheet revealed P4’s BFR was documented as 370 mL/min from 7:09 AM until the treatment was terminated at 9:06 AM. Further review revealed there was no rationale documented as to why the prescribed BFR was not achieved. 5. Review of P5’s treatment sheet, dated 07/29/2025, revealed a prescribed dialysate flow rate (DFR) 1.5 times the blood flow rate (BFR) of 400 milliliters per minute (equaling 600 mL/min). The treatment sheet revealed P5’s DFR was documented as 800 mL/min during the entire treatment. Further review revealed there was no rationale documented as to why the prescribed DFR was not achieved. 6. Review of P6’s treatment sheet, dated 07/26/2025, revealed a prescribed BFR of 400 milliliters per minute (mL/min). The treatment sheet revealed P6’s BFR was documented as 250 mL/min from 2:05 PM until the treatment was terminated at 3:37 PM. Further review revealed there was no rationale documented as to why the prescribed BFR was not achieved. Review of P6’s treatment sheet, dated 07/31/2025, revealed a prescribed BFR of 400 mL/min. The treatment sheet revealed P6’s BFR was documented as 300 mL/min during the entire treatment. Further review revealed there was no rationale documented as to why the prescribed BFR was not achieved. Review of P6’s treatment sheet, dated 08/05/2025, revealed a prescribed BFR of 400 mL/min. The treatment sheet revealed P6’s BFR was documented between 300 mL/min and 350 mL/min during the entire treatment. Further review revealed there was no rationale documented as to why the prescribed BFR was not achieved. Review of P6’s treatment sheet, dated 08/09/2025, revealed a prescribed BFR of 400 mL/min. The treatment sheet revealed P6’s BFR was documented as 350 mL/min from 1:32 PM until 2:02 PM. Further review revealed there was no rationale documented as to why the prescribed BFR was not achieved. 7. Review of P7’s treatment sheet, dated 07/31/2025, revealed a prescribed blood flow rate (BFR) of 400 milliliters per minute (mL/min). The treatment sheet revealed P7’s BFR was documented as 300 mL/min from 12:31 PM until the treatment was terminated at 2:20 PM. Further review revealed there was no rationale documented as to why the prescribed BFR was not achieved. During an interview on 08/14/2025 at 11:15 AM, Patient Care Technician (PCT) 2 stated she was expected to document the reasons why the prescribed blood flow rate and/or dialysate flow rate were not achieved. During an interview on 08/13/2025 at 4:24 PM, Registered Nurse (RN) 1 stated she was trained and expected to “write a note” when the prescribed blood flow rate and/or dialysate flow rate were not achieved. During an interview on 08/12/2025 at 2:55 PM, the Facility Administrator confirmed the staff was expected and trained to document a reason when the prescribed blood flow rate and/or dialysate flow rate were not achieved. During an interview on 08/14/2024 at 10:30 AM, the Medical Director stated staff should document the reasons for changes to the prescribed blood flow rate and/or dialysate flow rate.”

“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 7 of 7 sampled patients, Patient (P) 1, P2, P3, P4, P5, P6, and P7. Failure to monitor patients’ vital signs and/or machine parameters according to the facility’s policy during dialysis treatments provided an opportunity for changes to the patients’ vital signs, blood flow rate, dialysate flow rate, and/or arterial and venous pressures to be unrecognized and unaddressed and negatively impact the care provided to the 60 patients who received dialysis treatments at the facility. The findings include: Review of the facility’s 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. Review of P1’s treatment sheet, dated 07/22/2025, revealed vital signs and machine parameters were not documented for 61 minutes, from 1:32 PM until 2:33 PM. Review of P1’s treatment sheet, dated 07/29/2025, revealed machine parameters were not documented for 58 minutes, from 12:39 PM until 1:37 PM. 2. Review of P2’s treatment sheet, dated 07/28/2025, revealed vital signs and machine parameters were not documented for 62 minutes, from 12:07 PM until 1:09 PM and again for 46 minutes, from 2:18 PM until the treatment was terminated at 3:04 PM. Review of P2’s treatment sheet, dated 07/30/2025, revealed vital signs and machine parameters were not documented for 133 minutes, from 1:30 PM until 3:43 PM. Review of P2’s treatment sheet, dated 08/11/2025, revealed vital signs and machine parameters were not documented for 64 minutes, from 1:06 PM until 2:10 PM. 3. Review of P3’s treatment sheet, dated 07/28/2025, revealed machine parameters were not documented for 53 minutes, from 12:17 PM until 1:10 PM. Review of P3’s treatment sheet, dated 07/30/2025, revealed vital signs and machine parameters were not documented for 93 minutes, from 2:08 PM until 3:41 PM. Review of P3’s treatment sheet, dated 08/04/2025, revealed vital signs and machine parameters were not documented for 57 minutes, from 2:05 PM until 3:02 PM and again for 49 minutes, from 3:32 PM until the treatment was terminated at 4:21 PM. 4. Review of P4’s treatment sheet, dated 08/01/2025, revealed vital signs and machine parameters were not documented for 54 minutes, from 7:09 AM until 8:03 AM. Review of P4’s treatment sheet, dated 08/11/2025, revealed vital signs and machine parameters were not documented for 52 minutes, from 8:14 AM until 9:06 AM. 5. Review of P5’s treatment sheet, dated 07/22/2025, revealed vital signs were not documented for 59 minutes, from 10:05 AM until 11:04 AM. Review of P5’s treatment sheet, dated 07/24/2025, revealed vital signs were not documented for 61 minutes, from 11:02 AM until 12:03 PM. Review of P5’s treatment sheet, dated 07/26/2025, revealed machine parameters were not documented for 102 minutes, from 10:51 AM until 12:33 PM. Review of P5’s treatment sheet, dated 08/02/2025, revealed machine parameters were not documented for 70 minutes, from 11:02 AM until 12:12 PM. Review of P5’s treatment sheet, dated 08/07/2025, revealed machine parameters were not documented for 57 minutes, from 11:07 AM until 12:04 PM. 6. Review of P6’s treatment sheet, dated 07/22/2025, revealed vital signs were not documented for 63 minutes, from 1:01 PM until 2:04 PM. Review of P6’s treatment sheet, dated 07/31/2025, revealed machine parameters were not documented for 56 minutes, from 11:37 AM until 12:33 PM, and vital signs and machine parameters were not documented again for 61 minutes, from 2:02 PM until 3:03 PM. Review of P6’s treatment sheet, dated 08/02/2025, revealed machine parameters were not documented for 63 minutes, from 1:32 PM until 2:35 PM. 7. Review of P7’s treatment sheet, dated 07/24/2025, revealed vital signs were not documented for 61 minutes, from 12:01 PM until 1:02 PM. Review of P7’s treatment sheet, dated 07/26/2025, revealed machine parameters were not documented for 70 minutes, from 1:33 PM until 2:43 PM. During an interview on 08/12/2025 at 2:55 PM, the Facility Administrator stated staff was trained and expected to follow the facility’s policy to document vital signs and machine parameters every 30 minutes, but no longer than 45 minutes. During an interview on 08/14/2025 at 11:15 AM, Patient Care Technician (PCT) 2 stated vital signs and machine parameters were expected to be documented every 30 minutes. During an interview on 08/13/2025 at 4:24 PM, Registered Nurse (RN) 1 stated she was expected to document vital signs and machine parameters every 30 minutes. During an interview on 08/14/2025 at 10:30 AM, the Medical Director stated staff was expected to monitor vital signs and machine parameters every 30 minutes and not to go over 45 minutes.”