Fmc Dialysis Services Neuse River

“IC-CLEAN/DIRTY;MED PREP AREA;NO COMMON CARTS CFR(s): 494.30(a)(1)(i) Clean areas should be clearly designated for the preparation, handling and storage of medications and unused supplies and equipment. Clean areas should be clearly separated from contaminated areas where used supplies and equipment are handled. Do not handle and store medications or clean supplies in the same or an adjacent area to that where used equipment or blood samples are handled. When multiple dose medication vials are used (including vials containing diluents), prepare individual patient doses in a clean (centralized) area away from dialysis stations and deliver separately to each patient. Do not carry multiple dose medication vials from station to station. Do not use common medication carts to deliver medications to patients. If trays are used to deliver medications to individual patients, they must be cleaned between patients. This Standard is not met as evidenced by: 32003 Based on policy review, observation, personnel worksheet review and staff interview, the facility staff failed to prevent cross-contamination by not ensuring a staff member removed personal protective equipment when going from the in-center treatment area to the water room. The findings include: Review on February 14, 2025 of the facility’s policy, “Personal Protective Equipment” published November 6, 2023 revealed, “Purpose ...Responsibility ...Background ...Definitions ...Policy ...All personal protective equipment shall be removed prior to leaving the treatment area. ...” Observation on February 13, 2025 at 12:09 PM of a total chlorine test in the water room with Nurse #1 and Nurse #2 revealed, the nurses followed the facility’s process for total chlorine testing. At the end of the test, Patient Care Technician #1 entered the water room from the clean storage area while still wearing a white lab coat/gown. The technician obtained acid solution into a container and exited the water room through the clean storage area back to the in-center treatment area. Observation revealed the technician failed to remove the white lab coat/ gown before leaving the treatment area. Review of the personnel worksheet on February 14, 2025 revealed Patient Care Technician #1 was hired at the facility and infection control training was last completed in July 2024. Interview conducted February 14, 2025 at about 10:00 AM with the Clinical Manager revealed, the white lab coat/gown should be removed before leaving the in-center treatment area.”

“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: 32003 Based on policy review, chairside treatment observation, medical record reviews and staff interview, the facility staff failed to ensure a post-treatment nursing assessment was performed for 1 of 3 patients (Patients #5). The findings include: Review on February 14, 2025 of the facility’s policy, “Patient Assessment and Monitoring” published May 1, 2023 revealed, “Purpose...Responsibility...Definitions...Delegation...Data Collection...Pre-Treatment...During Treatment...Step 1...Step 3 [space] Machine Parameters and Extracorporeal Circuit [space] 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...Post-Treatment [space] Weight, Blood Pressure, Pulse, Respiration, Temperature, Observations, Access, Reported by the patient, State of well-being/Reported by the patient/General observations, Lungs sounds, Edema, Heart sounds...” Observation at the chairside on February 12, 2025 at 11:13 AM revealed the blood flow rate for Patient #5 was set at 500 milliliters per hour. Open medical record review on February 14, 2025 revealed Patient #5 was admitted to the in-center facility in 2015. Order summary review revealed the blood flow rate was ordered at 500 milliliters per hour for 300-minutes each treatment for three days per week. Treatment sheet review from February 1, 2025 through February 13, 2025 (six consecutive treatments) revealed, a post-treatment nursing assessment was not performed for the patient on February 7, 2025. Interview conducted February 14, 2025 at about 10:00 AM with the Clinical Manager revealed, a post-treatment nursing assessment was not performed for the patient on February 7, 2025.”

“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: 32003 Based on policy review, chairside treatment observations, medical record reviews and staff interview, the facility staff failed to follow the adequacy plan of care by not dialyzing patients at the prescribed blood flow rate for 2 of 3 patients (Patients #5 and #18). The findings include: Review on February 14, 2025 of the facility’s policy, “Patient Assessment and Monitoring” published May 1, 2023 revealed, “Purpose...Responsibility...Definitions...Delegation...Data Collection...Pre-Treatment...During Treatment...Step 1...Step 3 [space] Machine Parameters and Extracorporeal Circuit [space] 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...” 1. Observation at the chairside on February 12, 2025 at 11:13 AM revealed the blood flow rate for Patient #5 was set at 500 milliliters per hour. Open medical record review on February 14, 2025 revealed Patient #5 was admitted to the in-center facility in 2015. Order summary review revealed, the blood flow rate was ordered at 500 milliliters per hour for 300-minutes each treatment for three days per week. Treatment sheet review from February 1, 2025 through February 13, 2025 (six consecutive treatments) revealed, the patient was not dialyzed at the prescribed blood flow rate for 2 of 6 treatments (February 5, 2025 and February 12, 2025) and there was no documentation of any action taken by the staff. Interview conducted February 14, 2025 at about 10:00 AM with the Clinical Manager revealed, Patient #5 was not dialyzed at the prescribed blood flow rate for 2 of 6 treatments. 2. Observation at the chairside on February 12, 2025 at 10:30 AM revealed the blood rate for Patient #18 was set at 450 milliliters per hour. Open medical record review on February 14, 2025 revealed Patient #18 was admitted to the in-center facility in 2018. Order summary review revealed, the blood flow rate was ordered at 450 milliliters per hour for 240-minutes each treatment for three days per week. Treatment sheet review from February 1, 2025 through February 13, 2025 (six consecutive treatments) revealed, the patient was not dialyzed at the prescribed blood flow rate for 1 of 6 treatments (February 4, 2025) and there was no documentation of any action taken by the staff. Interview conducted February 14, 2025 at about 10:00 AM with the Clinical Manager revealed, Patient #18 was not dialyzed at the prescribed blood flow rate for 1 of 6 treatments.”