Fmc - Masonic Home 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: 52065 Based on interview, record review, and facility policy review, the facility failed to follow dialysis prescriptions ordered by the medical provider for 1 (Patient #3) of 7 sampled patients. The findings included: Review of facility 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.” Review of Patient #3’s demographic information sheet indicated the facility admitted the patient on 12/13/2023. According to the demographic information sheet, the patient had a diagnosis of end stage renal disease. Review of Patient #3’s “Treatment Sheet” dated 01/27/2025 revealed a prescribed blood flow rate (BFR) of 450 milliliters per min (mL/min). The Treatment Sheet indicated Patient #3’s BFR was 350 mL/min from 12:33 PM until 3:05 PM and 400 mL/min from 3:35 PM until the treatment ended at 4:11 PM. There was no rationale documented as to why the prescribed BFR was not achieved. Review of Patient #3’s “Treatment Sheet” dated 01/31/2025 revealed a prescribed BFR of 450 mL/min. The Treatment Sheet indicated Patient #3’s BFR was 300 mL/min at 12:11 PM; 325 mL/min from 12:32 PM until 1:02 PM; 350 mL/min at 1:35 PM; and 400 mL/min from 2:05 PM until 2:33 PM. There was no rationale documented as to why the prescribed BFR was not achieved. Review of Patient #3’s “Treatment Sheet” dated 02/03/2025 revealed a prescribed BFR of 450 mL/min. The Treatment Sheet indicated Patient #3’s BFR was 400 mL/min from 2:30 PM until 3:09 PM and 350 mL/min at 4:22 PM. There was no rationale documented as to why the prescribed BFR was not achieved. During an interview on 02/12/2025 at 10:40 AM, the Medical Director stated staff were expected to document a reason when the prescribed BFR was not achieved. During an interview on 02/11/2025 at 10:30 AM, the Clinic Nurse Manager stated staff were trained and expected to follow the physicians’ orders and document reasons when the prescribed BFR was not achieved. During an interview on 02/12/2025 at 11:00 AM, Patient Care Technician #5 stated staff were trained and expected to write a reason for changes to the prescribed BFR.”

“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: 52065 Based on interview, record review, and facility policy review, the facility failed to monitor patients’ vital signs according to policy for 3 (Patients #1, #2, and #3) of 8 sampled patients. Failure to monitor patients’ vitals and 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 32 patients who received dialysis treatments at the facility. The findings included: Review of 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 [sic] or more often as needed but not to exceed 45 minutes or per state regulations.” The policy also specified, “Follow the steps below for monitoring patient and machine parameters during treatment: Step 1: Blood Pressure - Record blood pressure. Recheck blood pressures after a drop that requires interventions such as administering normal saline. Reposition electronic cuff or use a manual cuff for aberrant blood pressure readings. Report to the nurse: - Systolic blood pressures greater than 180 mm/Hg [millimeters mercury] - Diastolic blood pressure greater than 100 mm/Hg - Blood Pressure less than or equal to 100 mm/Hg systolic Pulse - Record pulse. Verify pulse manually if automated readings display below 60 or greater than 100 beats per minute. Report to the nurse patients whose heart rates have dropped below 60, risen above 100 or become irregular.” 1. Review of Patient #1’s demographic information sheet indicated the facility admitted the patient on 07/12/2024. According to the demographic information sheet, the patient had a diagnosis of end stage renal disease. Review of Patient #1’s “Treatment Sheet” dated 02/05/2025 indicated the patient’s blood pressures were outside the parameters specified by the facility policy at the following times: - 7:26 AM: 215/114 mm/Hg - 8:04 AM: 230/122 mm/Hg - 9:10 AM: 183/94 mm/Hg There was no documentation to indicate the out-of-parameter blood pressures were recognized or addressed. Review of Patient #1’s “Treatment Sheet” dated 02/07/2025 indicated the patient’s blood pressures were outside the parameters specified by the facility policy at the following times: - 8:04 AM: 192/107 mm/Hg - 8:37 AM: 196/98 mm/Hg - 10:30 AM: 191/96 There was no documentation to indicate the out-of-parameter blood pressures were recognized or addressed. 2. Review of Patient #2’s demographic information sheet indicated the facility admitted the patient on 12/23/2024. According to the demographic information sheet, the patient had a diagnosis of end stage renal disease. Review of Patient #2’s “Treatment Sheet” dated 01/27/2025 indicated the patient’s pulse was outside the parameters specified by the facility’s policy at the following times: - 11:55 AM: 55 beats per minute (bpm) - 12:32 PM: 52 bpm - 1:13 PM: 55 bpm - 1:34 PM: 49 bpm - 2:06 PM: 46 bpm - 2:34 PM: 51 bpm - 3:01 PM: 53 bpm - 3:25 PM: 51 bpm There was no documentation to indicate the out-of-parameter pulse rates were recognized or addressed. Review of Patient #2’s “Treatment Sheet” dated 01/29/2025 indicated the patient’s pulse was outside the parameters specified by the facility’s policy at the following times: - 12:30 PM: 52 bpm - 1:04 PM: 50 bpm - 1:33 PM: 51 bpm - 2:00 PM: 50 bpm - 2:37 PM: 52 bpm - 3:03 PM: 55 bpm There was no documentation to indicate the out-of-parameter pulse rates were recognized or addressed. Review of Patient #2’s “Treatment Sheet” dated 01/31/2025 indicated the patient’s pulse was outside the parameters specified by the facility policy at the following times: - 12:37 PM: 54 bpm - 1:03 PM: 50 bpm - 1:37 PM: 52 bpm - 2:03 PM: 49 bpm - 2:34 PM: 49 bpm - 3:02 PM: 50 bpm - 3:28 PM: 51 bpm There was no documentation to indicate the out-of-parameter pulse rates were recognized or addressed. 3. Review of Patient #3’s demographic information sheet indicated the facility admitted the patient on 12/13/2023. According to the demographic information sheet, the patient had a diagnosis of end stage renal disease. Review of Patient #3’s “Treatment Sheet” dated 01/27/2025 indicated the patient’s pulse was outside the parameters specified by the facility’s policy at the following times: - 12:33 PM: 55 bpm - 1:02 PM: 57 bpm - 2:30 PM: 59 bpm - 2:36 PM: 59 bpm - 3:05 PM: 52 bpm - 3:35 PM: 57 bpm - 4:10 PM: 48 bpm There was no documentation to indicate the out-of-parameter pulse rates were recognized or addressed. Review of Patient #3’s “Treatment Sheet” dated 01/29/2025 indicated the patient’s pulse was outside the parameters specified by the facility’s policy at the following times: - 12:31 PM: 55 bpm - 1:02 PM: 54 bpm - 1:33 PM: 53 bpm - 2:15 PM: 45 bpm - 2:22 PM: 33 bpm - 2:35 PM: 40 bpm - 3:05 PM: 54 bpm - 4:04 PM: 53 bpm There was no documentation to indicate the out-of-parameter pulse rates were recognized or addressed. During an interview on 02/12/2025 at 10:40 AM, the Medical Director stated she expected staff to report out-of-parameter vital signs to the nurse and implement interventions as required and to report to the physician when needed.”