Heartland Kidney Center

“IC-ASEPTIC TECHNIQUES FOR IV MEDS CFR(s): 494.30(b)(2) [The facility must-] (2) Ensure that clinical staff demonstrate compliance with current aseptic techniques when dispensing and administering intravenous medications from vials and ampules; and This Standard is not met as evidenced by: 17026 Based on observations and staff interview, the facility staff failed to ensure medications (five containers) and antimicrobial skin and wound cleanser (two containers) were not expired. This had the potential to effect all patients on dialysis and cause an increase in complications. The facility census was 27. Findings included: 1. Observation on 6/3/24 at 11:43 AM of the home peritoneal dialysis training room showed five containers of Ferric Citrate (medication used to control the phosphorous level) tablets that expired 3/31/24. 2. Observation on 6/3/24 at 11:41 AM of the home peritoneal dialysis training room showed two containers of antimicrobial skin and wound cleanser that expired 7/11/23. 3. During an interview on 6/4/24 at 12:30 PM, the facility manager said staff need to ensure the medications and supplies were not expired.”

“POC-ACHIEVE ADEQUATE CLEARANCE CFR(s): 494.90(a)(1) Achieve and sustain the prescribed dose of dialysis to meet a hemodialysis Kt/V of at least 1.2 and a peritoneal dialysis weekly Kt/V of at least 1.7 or meet an alternative equivalent professionally-accepted clinical practice standard for adequacy of dialysis. This Standard is not met as evidenced by: 17026 Based on record review and staff interview, the facility staff failed to follow the blood flow rate or the dialysate flow rate for two patients (Patient # 1 and # 3) out of five clinical records reviewed. This had the potential to effect all patients on dialysis and cause an increase in complications. The facility census was 27. Findings included: 1. Review of the treatment flow sheets dated 5/10/24, 5/27/24, and 5/31/24 for Patient # 1 showed the patient’s physician directed staff to set the dialysate flow rate at 800, but staff set the dialysate flow rate at 600 for the patient’s dialysis treatment. 2. Review of the treatment flow sheet dated 5/31/24 for Patient # 3 showed the patient’s physician directed staff to set the blood flow rate at 300, but staff set the blood flow rate at 400 for the patient’s dialysis treatment. 3. During an interview on 6/4/24 at 12:30 PM, the facility manager said staff should follow the physician order for the blood flow rate and dialysate flow rate.”

“MD RESP-ENSURE ALL ADHERE TO P&P CFR(s): 494.150(c)(2)(i) The medical director must- (2) Ensure that- (i) All policies and procedures relative to patient admissions, patient care, infection control, and safety are adhered to by all individuals who treat patients in the facility, including attending physicians and nonphysician providers; This Standard is not met as evidenced by: 17026 Based on record review and staff interview, the facility staff failed to conduct a pre-nursing assessment within one hour of a patient starting on dialysis treatment for three patients (Patient # 2, # 3, and # 4) out of five clinical records reviewed. This had the potential to effect all patients on dialysis and cause an increase in complications. The facility census was 27. Findings included: 1. Review of the treatment flow sheet dated 5/27/24 for Patient # 4 showed staff started the patient on dialysis treatment at 10:31 AM but did not complete the pre-nursing assessment for the patient until 12:12 PM. 2. Review of the treatment flow sheet dated 5/31/24 for Patient # 2 showed staff started the patient on dialysis treatment at 8:20 AM but did not complete the pre-nursing assessment for the patient until 9:55 AM. 3. Review of the treatment flow sheet dated 5/31/24 for Patient # 3 showed staff started the patient on dialysis treatment at 9:07 AM but did not complete the pre-nursing assessment for the patient until 10:22 AM. 4. During an interview on 6/4/24 at 12:30 PM, the facility manager said staff need to complete the pre-nursing assessment within one hour of a patient starting on dialysis treatment, or document a note if they are doing a late medical record entry.”