Fmc - Joplin East

“CARBON ADSORP-MONITOR, TEST FREQUENCY CFR(s): 494.40(a) 6.2.5 Carbon adsorption: monitoring, testing freq Testing for free chlorine, chloramine, or total chlorine should be performed at the beginning of each treatment day prior to patients initiating treatment and again prior to the beginning of each patient shift. If there are no set patient shifts, testing should be performed approximately every 4 hours. Results of monitoring of free chlorine, chloramine, or total chlorine should be recorded in a log sheet. Testing for free chlorine, chloramine, or total chlorine can be accomplished using the N.N-diethyl-p-phenylene-diamine (DPD) based test kits or dip-and-read test strips. On-line monitors can be used to measure chloramine concentrations. Whichever test system is used, it must have sufficient sensitivity and specificity to resolve the maximum levels described in [AAMI] 4.1.1 (Table 1) [which is a maximum level of 0.1 mg/L]. Samples should be drawn when the system has been operating for at least 15 minutes. The analysis should be performed on-site, since chloramine levels will decrease if the sample is not assayed promptly. This Standard is not met as evidenced by: 17026 Based on observation and staff interview, the facility staff failed to properly check the chlorine level in the water. Elevated chlorine levels can cause hemolysis (destruction of red blood cells) for patients on dialysis treatment. This had the potential to effect all patients on dialysis treatment and cause in increase in complications. The facility census was 101. Findings included: 1. Observation on 3/11/24 at 1:01 PM showed Certified Clinical Hemodialysis Technician (CCHT) (C) checked the chlorine level in the water. CCHT (C) swished the test strip for 60 seconds, but did not wait 20 seconds after swishing the test strip to compare the test strip to the color chart. 2. During an interview on 3/11/24 at 1:03 PM, Registered Nurse (RN) (I) said staff should wait 20 seconds after swishing the test strip to compare the test strip to the color chart.”

“DIALYS PROPORT-MONITOR PH/CONDUCTIVITY CFR(s): 494.40(a) 5.6 Dialysate proportioning: monitor pH/conductivity It is necessary for the operator to follow the manufacturer’s instructions regarding dialysate conductivity and to measure approximate pH with an independent method before starting the treatment of the next patient. This Standard is not met as evidenced by: 17026 Based on observations and staff interview, the facility staff failed to ensure three conductivity solutions were not expired. This had the potential to effect all patients on dialysis treatment and cause an increase in complications. The facility census was 101. Findings included: 1. Observation on 3/11/24 at 1:18 PM of the treatment area showed an approximately on-fourth full standard buffer solution 4.0 that expired 10/26/23. 2. Observation on 3/11/24 at 1:16 PM of the treatment area showed an approximately one-fourth full standard buffer solution 10.0 that expired 2/23/24. 3. Observation on 3/11/24 at 1:15 PM of the treatment area showed an approximately one-half full conductivity solution 14.0 that expired 2/29/24. 4. During an interview on 3/11/24 at 1:19 PM, the clinic manager said staff need to ensure the conductivity solutions are not expired.”

“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: 17026 Based on record review and staff interview, the facility staff failed to follow the physician order for the dialysate flow rate for three patients (Patient # 2, # 3, and # 4) out of 10 clinical records reviewed. This had the potential to effect all patients on dialysis treatment and cause an increase in complications. The facility census was 101. Findings included: 1. Review of the treatment flow sheet dated 3/11/24 for Patient # 2 showed the physician directed staff to set the dialysate flow rate at 600. The treatment flow sheet showed staff set the dialysate flow rate at 800 during the patient’s dialysis treatment. 2. Review of the treatment flow sheet dated 3/6/24 for Patient # 3 showed the physician directed staff to set the dialysate flow rate at 700. The treatment flow sheet showed staff set the dialysate flow rate at 800 during the patient’s dialysis treatment. 3. Review of the treatment flow sheet dated 3/11/24 for Patient # 4 showed the physician directed staff to set the dialysate flow rate at 700. The treatment flow sheet showed staff set the dialysate flow rate at 800 during the patient’s dialysis treatment. 4. During an interview on 3/12/24 at 2:15 PM, the clinic manager said staff should follow the physician order for the dialysate flow rate.”

“PA-ASSESS B/P, FLUID MANAGEMENT NEEDS CFR(s): 494.80(a)(2) The patient’s comprehensive assessment must include, but is not limited to, the following: Blood pressure, and fluid management needs. This Standard is not met as evidenced by: 17026 Based on record review and staff interview, the facility staff failed to check the blood pressure every 30 minutes for two patients (Patient # 1 and # 2) out of 10 clinical records reviewed. This had the potential to effect all patients on dialysis treatment and cause an increase in blood pressure complications. The facility census was 101. Findings included: 1. Review of the treatment flow sheet dated 3/11/24 for Patient # 1 showed staff checked the patient’s blood pressure at 1:37 PM but did not check the blood pressure again until 3:00 PM during the patient’s dialysis treatment. 2. Review of the treatment flow sheet dated 3/11/24 for Patient # 2 showed staff checked the patient’s blood pressure at 2:24 PM but did not check the blood pressure again until 4:04 PM during the patient’s dialysis treatment. 3. During an interview on 3/12/24 at 2:15 PM, the clinic manager said staff should check the patient’s blood pressure every 30 minutes during dialysis treatment.”

“LAB-CLIA LABS/MEET NEEDS OF PTS CFR(s): 494.130 The dialysis facility must provide or make available, laboratory services (other than tissue pathology and histocompatibility) to meet the needs of the ESRD patient. Any laboratory services, including tissue pathology and histocompatibility must be furnished by or obtained from, a facility that meets the requirements for laboratory services specified in part 493 of this chapter. This Standard is not met as evidenced by: 17026 Based on observations and staff interview, the facility staff failed to ensure six blood culture kits and 16 laboratory tubes were not expired. This had the potential to effect all patients on dialysis treatment and cause an increase in complications. The facility census was 101. Findings included: 1. Observation on 3/11/24 at 1:07 PM of the laboratory area showed six blood culture kits that expired 10/7/23. 2. Observation on 3/11/24 at 1:05 PM of the laboratory area showed 16 laboratory tubes that expired 11/30/23. 3. During an interview on 3/11/24 at 1:08 PM, the clinic manager said staff need to ensure the blood culture kits and laboratory tubes are not expired.”