Fmc Wake Dialysis Clinic

“GOV-INVOL DISCHARGE PROCESS REQUIREMENTS CFR(s): 494.180(f)(4) The medical director ensures that no patient is discharged or transferred from the facility unless - (4) The facility has reassessed the patient and determined that the patient’s behavior is disruptive and abusive to the extent that the delivery of care to the patient or the ability of the facility to operate effectively is seriously impaired, in which case the medical director ensures that the patient’s interdisciplinary team- (i) Documents the reassessments, ongoing problems(s), and efforts made to resolve the problem(s), and enters this documentation into the patient’s medical record; (ii) Provides the patient and the local ESRD Network with a 30-day notice of the planned discharge; (iii) Obtains a written physician’s order that must be signed by both the medical director and the patient’s attending physician concurring with the patient’s discharge or transfer from the facility; (iv) Contacts another facility, attempts to place the patient there, and documents that effort; and (v) Notifies the State survey agency of the involuntary transfer or discharge. (5) In the case of immediate severe threats to the health and safety of others, the facility may utilize an abbreviated involuntary discharge procedure. This Standard is not met as evidenced by: 26622 Based on facility policy review, medical record review and interview, the facility failed to provide a 30-day discharge notification to a hospitalized patient and/or guardian for 1 of 1 sampled discharged patient records reviewed. Findings include: Review on 11/21/2024 of the facility policy titled “Immediate and Non-Immediate Involuntary Patient Discharge” published 11/02/2024 revealed “... Non-Immediate Involuntary Discharge (30-day Discharge) Patient is notified in person and by letter that effective in 30 days, their current (Name) clinic is no longer able to provide them with medical care or dialysis treatments. This is based on...(...unable to meet medical needs...). ... Patient Notification Non-immediate involuntary discharge: The patient must be notified by certified letter and regular mail at least 30 days prior to the non-immediate involuntary discharge. ... Reason for Non-Immediate Involuntary Discharge (30-day notice required) ... Facility Unable to Meet Documented Medical Needs If a patient’s medical condition is deemed to require non-routine, extensive monitoring, or other interventions that are not available in the facility, discharge of the patient may be necessary. Depending on the severity of the medical need, the discharge may need to be less than 30 days. All reasonable alternatives for continuing to provide care to the patient in the facility must be considered before discharge occurs. A meeting between the IDT (interdisciplinary team) and the patient and/or patient’s representative or family should take place to discuss the patient’s current status and barriers to providing safe treatment environment for the patient. ...” Review on 11/20/2024 of the medical record for Patient #1 revealed a 61-year-old female admitted for ICHD (in-center hemodialysis) on 08/11/2020. Review of the medical record revealed a “special attention” discharge order placed in the electronic medical record on 11/21/2024 at 1707. Review of the order revealed a start date/time of 11/12/2024 at 1606. Review of the discharge order revealed “Instruction: Patient to be discharged due to no longer meeting outpatient dialysis criteria per Dr. (Name). Review of the medical record revealed the last documented conversation with Patient #1’s daughter was on 09/20/2024 at 1019. The documentation by the Facility Administrator revealed no evidence of Patient #1’s discharge being discussed during the conversation with the patient’s daughter. Review of a nephrology physician progress note documented on 09/25/2024 at 0953 and 09/26/2024 at 0909 revealed “End stage renal disease ... Not an outpatient dialysis candidate given critical airway” with no documentation of plans for discharge from the ICHD outpatient clinic. Review of the medical record failed to reveal documented conversations with the patient/patient representative related to discharge plans. Interview on 11/20/2024 at 1420 with Social Worker (SW) #1 revealed that the SW had not had any conversations with the patient or patient’s daughter about discharge. Interview on 11/21/2024 at 1615 with Facility Administrator (FA) #2 revealed the facility was unable to locate any documentation in the medical record related to discharge conversations with the patient and/or patient’s daughter. The FA indicated that she had a conversation with the patient’s daughter in September 2024 and that review of the documented conversation did not reveal a discussion about the possibility of discharge. Interview revealed the last documented in-clinic provider note was written on 12/07/2023. The FA did have access to nephrology progress notes documented in September 2024 but a review of the notes did not reveal documentation of discharge conversations with the patient and/or the patient’s daughter. Interview revealed that the FA was unable to locate documentation of discharge discussions for Patient #1 in the medical record. Interview revealed that the facility received an email from the attending physician to discharge Patient #1 due to the clinics inability to provide dialysis in the outpatient setting due to the patient’s current medical care needs. NC00216338, NC00217675, NC00212162, NC00211461”