Davita Madisonville Dialysis Center

“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: 30271 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 3 (Patient #1, #2, and #3) of 4 sampled patients. The findings include: A facility policy titled, “Pre-Intra-Post Treatment Data Collection, Monitoring and Nursing Assessment,” revised April 2024, indicated, “10. If the dialysis prescription is not being met (including dialysis flow rate or change to /inability to obtain prescribed blood flow rate) the reason will be documented and the licensed nurse informed. 11. Abnormal findings or findings outside of any patient specific physician ordered parameters will be reported to the licensed nurse immediately.” The policy revealed, “The licensed nurse will use his/her clinical judgement based on individual patient needs to determine if any clinical interventions are necessary. 12. The licensed nurse notifies the physician as needed of changes in patient status. 13. All findings, interventions and patient response will be documented in the patient’s medical record.” 1. Patient #1’s “Treatment Details Report” dated 01/27/2025 revealed a prescribed blood flow rate (BFR) of 400 milliliters per minute (mL/min). The Treatment Details Report revealed Patient #1’s BFR was documented as 250 mL/min from 1:21 PM until 3:15 PM, the end of treatment. The Treatment Details Report revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #1’s “Treatment Details Report” dated 01/29/2025 revealed a prescribed BFR of 400 mL/min. The Treatment Details Report revealed Patient #1’s BFR was documented as 300 mL/min from 12:32 PM until 2:48 PM, the end of treatment. The Treatment Details Report revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #1’s “Treatment Details Report” dated 02/05/2025 revealed a prescribed BFR of 400 mL/min. The Treatment Details Report revealed Patient #1’s BFR was documented as 350 mL/min from 11:12 AM until 2:15 PM, the end of treatment. The Treatment Details Report revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #1’s “Treatment Details Report” dated 02/07/2025 revealed a prescribed BFR of 400 mL/min. The Treatment Details Report revealed Patient #1’s BFR was documented as 350 mL/min from 11:09 AM until 12:08 PM. The Treatment Details Report revealed at 12:38 PM the patient’s BFR was reduced to 300 mL/min. The Treatment Details Report revealed that from 1:08 PM to 2:08 PM the patient’s BFR was reduced to 250 mL/min. The Treatment Details Report revealed there was no rationale documented as to why the prescribed BFR was not achieved. During an interview on 02/10/2025 at 12:00 PM, the Medical Director (MD) #3 stated his expectation was to be notified if there were any adverse findings or an inability to meet treatment orders. 2. Patient #2’s “Treatment Details Report” dated 01/27/2025 revealed a prescribed blood flow rate (BFR) of 300 milliliters per minute (mL/min). The Treatment Details Report revealed Patient #2’s BFR was documented as 400 mL/min from 6:49 AM until 8:52 AM. The Treatment Details Report revealed that from 8:52 AM until 9:18 AM the patient’s BFR was documented as 200 mL/min. The Treatment Details Report revealed from 9:18 AM until 10:25 AM the patient’s BFR was documented as 400 mL/min. The Treatment Details Report revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #2’s “Treatment Details Report” dated 01/29/2025 revealed a prescribed BFR of 300 mL/min. The Treatment Details Report revealed Patient #2’s BFR was documented as 400 mL/min from 7:18 AM until 10:18 AM. The Treatment Details Report revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #2’s “Treatment Details Report” dated 01/31/2025 revealed a prescribed BFR of 300 mL/min. The Treatment Details Report revealed Patient #2’s BFR was documented as 400 mL/min from 6:53 AM until 10:22 AM. The Treatment Details Report revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #2’s “Treatment Details Report” dated 02/03/2025 revealed a prescribed BFR of 300 mL/min. The Treatment Details Report revealed Patient #2’s BFR was documented as 400 mL/min from 6:50 AM until 10:00 AM. The Treatment Details Report revealed there was no rationale documented as to why the prescribed BFR was not achieved. During an interview on 02/10/2025 at 12:00 PM, the Medical Director (MD) #3 stated his expectation was to be notified if there were any adverse findings or an inability to meet treatment orders. During an interview on 02/12/2025 at 2:00 PM, the Group Facility Administrator (GFA) #8 confirmed the staff did not document the reason the BFR was not met. GFA #8 confirmed staff did not document notification to the Registered Nurse (RN) of a decreased ability to meet the ordered BFR. She confirmed that during Patient #2’s treatment the BFR was set at 400 mL/min when the patient’s orders were for 300 mL/min. 3. Patient #3’s “Treatment Details Report” dated 04/15/2024 revealed a prescribed blood flow rate (BFR) of 400 milliliters per minute (mL/min). The Treatment Details Report revealed Patient #2’s BFR was documented as 450 mL/min from 10:08 AM until 12:40 PM. The Treatment Details Report revealed there was no rationale documented as to why the prescribed BFR was not achieved. Patient #3’s “Treatment Details Report” dated 04/17/2024 revealed a prescribed BFR of 400 mL/min. The Treatment Details Report revealed Patient #2’s BFR was documented as 415 mL/min from 10:18 AM until 10:39 PM. The Treatment Details Report revealed there was no rationale documented as to why the prescribed BFR was not achieved. During an interview on 02/10/2025 at 12:00 PM, the Medical Director (MD) #3 stated his expectation was to be notified if there were any adverse findings or an inability to meet treatment orders.”