Fmc -Lake Cumberland

“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 37 in-center patients who received dialysis treatments at the facility. 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 04/24/2025 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 (x) the BFR. Patient #1’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 #1’s treatment sheet dated 04/26/2025 revealed a prescribed BFR of 400 mL/min and a prescribed DFR of 1.5 x the BFR. Patient #1’s DFR was documented as 800 mL/min from 12:31 PM until the treatment was terminated at 2:52 PM. There was no rationale documented why the prescribed DFR was not achieved. Patient #1’s treatment sheet dated 04/28/2025 revealed a prescribed BFR of 400 mL/min and a prescribed DFR of 1.5 x the BFR. Patient #1’s DFR was documented as 800 mL/min from 12:02 PM until the treatment was terminated at 2:27 PM. There was no rationale documented why the prescribed DFR was not achieved. Patient #1’s treatment sheet dated 05/02/2025 revealed a prescribed BFR of 400 mL/min. Patient #1’s BFR was documented as 450 mL/min from 11:32 AM until the treatment was terminated at 2:33 PM. There was no rationale documented why the prescribed BFR was not achieved. Patient #1’s treatment sheet dated 05/09/2025 revealed a prescribed DFR of 800 mL/min. Patient #1’s DFR was documented as 600 mL/min from 11:08 AM until 1:33 PM . There was no rationale documented why the prescribed DFR was not achieved. Patient #1’s treatment sheet dated 05/12/2025 revealed a prescribed BFR of 400 mL/min. Patient #1’s BFR was documented as 450 mL/min from 11:00 AM until the treatment was terminated at 2:17 PM. There was no rationale documented why the prescribed BFR was not achieved. 2. Patient #2’s treatment sheet dated 04/24/2025 revealed a prescribed blood flow rate (BFR) of 350 milliliters per minute (mL/min). Patient #2’s BFR was documented as 400 mL/min during the entire treatment. There was no rationale documented why the prescribed BFR was not achieved. Patient #2’s treatment sheet dated 04/26/2025 revealed a prescribed BFR of 350 mL/min and a prescribed dialysate flow rate (DFR) of 1.5 times (x) the BFR. Patient #2’s DFR was documented as 800 mL/min from 7:31 AM until the treatment was terminated at 8:52 AM. There was no rationale documented why the prescribed DFR was not achieved. Patient #2’s treatment sheet dated 04/30/2025 revealed a prescribed BFR of 350 mL/min. Patient #2’s BFR was documented as 400 mL/min during the entire treatment. There was no rationale documented why the prescribed BFR was not achieved. Patient #2’s treatment sheet dated 05/03/2025 revealed a prescribed BFR of 350 mL/min. Patient #2’s BFR was documented as 400 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 04/30/2025 revealed a prescribed blood flow rate (BFR) of 400 milliliters per minute (mL/min). Patient #3’s BFR was documented as 350 mL/min from 9:02 AM until the treatment was terminated at 9:27 AM. There was no rationale documented why the prescribed BFR was not achieved. 4. Patient #4’s treatment sheet dated 04/29/2025 revealed a prescribed blood flow rate (BFR) of 400 milliliters per minute (mL/min). Patient #4’s BFR was documented as 350 mL/min during the entire treatment. There was no rationale documented why the prescribed BFR was not achieved. 5. Patient #5’s treatment sheet dated 04/25/2025 revealed a prescribed blood flow rate (BFR) of 400 milliliters per minute (mL/min). Patient #5’s BFR was documented as 350 mL/min from 12:02 PM until 3:02 PM. There was no rationale documented why the prescribed BFR was not achieved. Patient #5’s treatment sheet dated 05/02/2025 revealed a prescribed BFR of 400 mL/min. Patient #5’s BFR was documented as 350 mL/min from 12:01 PM until the treatment was terminated at 12:45 PM. There was no rationale documented why the prescribed BFR was not achieved. Patient #5’s treatment sheet dated 05/09/2025 revealed a prescribed BFR of 400 mL/min. Patient #5’s BFR was documented as 350 mL/min from 1:45 PM until the treatment was terminated at 2:55 PM. There was no rationale documented why the prescribed BFR was not achieved. During an interview on 05/14/2025 at 1:05 PM, the Clinical Manager confirmed staff were trained and expected to document a “reason why” when the prescribed BFRs and/or DFRs were not achieved. During an interview on 05/14/2025 at 3:16 PM, Registered Nurse #1 stated she was trained and expected to “chart” why the prescribed BFRs and/or DFRs were not achieved. During an interview on 05/14/2025 at 3:38 PM, Certified Clinical Hemodialysis Technician #3 confirmed she was trained and expected to “document why” the prescribed BFRs and/or DFRs were not achieved. During an interview on 05/15/2025 at 8:22 AM, the Medical Director confirmed the staff are expected to follow the prescribed BFR and/or DFR and document a reason why the BFR and/or DFR were not achieved.”

“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 machine parameters according to the expectations in their policy for 4 (Patients #1, #3, #4, and #5) of 5 sampled patients. 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 37 patients who received dialysis treatments at the facility. Findings included: 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 05/09/2025, revealed machine parameters were not documented for 55 minutes, from 11:08 AM until 12:03 PM. 2. Patient #3’s treatment sheet, dated 04/23/2025, revealed machine parameters were not documented for 58 minutes, from 7:05 AM until 8:03 AM. 3. Patient #4’s treatment sheet, dated 05/01/2025, revealed vital signs and machine parameters were not documented for 59 minutes, from 8:02 AM until 9:01 AM. 4. Patient #5’s treatment sheet, dated 04/25/2025, revealed machine parameters were not documented for 62 minutes, from 2:00 PM until 3:02 PM. During an interview on 05/14/2025 at 1:05 PM, the Clinical Manager confirmed staff were expected to document vital signs and machine parameters every 30 minutes and not to exceed every 45 minutes per the facility’s policy. During an interview on 05/14/2025 at 3:16 PM, Registered Nurse #1 confirmed staff were trained and expected “to do checks [vital signs and machine parameters] every 30 minutes.” During an interview on 05/14/2025 at 3:38 PM, Certified Clinical Hemodialysis Technician #3 stated vital signs and machine parameters were expected to be documented “at least every 30 minutes.” During an interview on 05/15/2025 at 8:22 AM, the Medical Director confirmed staff were expected to document vital signs and machine parameters every 30 minutes and not to exceed every 45 minutes per the facility’s policy.”