Fmc Rai Care Centers Goldsboro

“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: 26622 Based on policy review, medical records review, and staff interviews, the facility staff failed to follow the adequacy plan of care by not dialyzing 6 of 6 (Patients #2, #6, #4, #5, #1 and #3) in-center hemodialysis patients at the prescribed Blood Flow Rate (BFR) and/or treatment duration. Findings include: A review on 08/14/2025 of the facility’s policy and procedure, “Patient Assessment and Monitoring,” published 05/01/2023, 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. ...” A review on 08/14/2025 of the facility’s policy and procedure, “Unable to Achieve Prescribed Blood Flow Rate,” published 11/01/2021, revealed “Purpose ...Responsibility ... Background ...Policy (space) Staff ... will recognize and report to the nurse in charge the inability to achieve prescribed blood flow rate ... Documentation (space) Document in patient’s treatment record what action taken to address the inadequate blood flow and if unable to resolve. The nurse shall document any physician orders. ...” A review on 08/14/2025 of the policy and procedure “Early Termination or Arriving Late for Treatment” revised 06/18/2025 revealed, “...Early termination ...The RN who evaluates the patient must document the rationale for early termination and reinforce the consequences of not receiving the entire prescribed treatment. The RN is responsible to... document on the ‘AMA’, or Against Medical Advice form...” 1. Review on 08/13/2025 of the medical record for Patient #2 revealed an 85-year-old female that had been admitted to the facility for in-center hemodialysis (ICHD) treatment on 05/14/2025. A review of the Physician orders revealed Patient #2’s Blood Flow Rate (BFR) was ordered at 400 with a treatment duration order for 3 hours (hrs) and 30 minutes (min). Review of the Treatment Flowsheet dated 07/28/2025 revealed Patient #2’s hemodialysis treatment was initiated at 1223 and ended at 1514 for a duration of 2 hrs and 51 min (shortened by 39 minutes) with no evidence of an AMA (Against Medical Advice) form completed. Review of the Treatment Flowsheet dated 07/30/2025 revealed Patient #2’s hemodialysis treatment was initiated at 1217 and ended at 1442 for a duration of 2 hrs and 25 min (shortened by 65 minutes) with no evidence of an AMA (Against Medical Advice) form completed. Review of the Treatment Flowsheet dated 08/04/2025 revealed Patient #2’s hemodialysis treatment was initiated at 1232 and ended at1554 (3 hrs and 22 min). Review of the Flowsheet revealed Patient #2’s BFR average was 330, with no documentation for the decreased BFR and no documentation of the Registered Nurse notification. Interview on 08/13/2025 at 1500 with the Clinical Manager revealed that the facility nursing staff were expected to obtain a signed AMA (Against Medical Advice) form for every patient that received a shortened treatment duration or document the patient’s refusal to sign on the AMA form. The interview revealed that the patient care technicians were expected to notify the nursing staff anytime they increased and/or decreased the patient’s BFR, or if they were unable to achieve the ordered BFR. The interview revealed that the nursing staff should have assessed and documented the reason for the decreased BFR during the patient’s treatment. 2. Review on 08/13/2025 of the medical record for Patient #6 revealed a 55-year-old male that had been admitted to the facility for in-center hemodialysis (ICHD) treatment on 09/19/2019. A review of the Physician orders revealed Patient #6’s Blood Flow Rate (BFR) was ordered at 450 with a treatment duration order for 4 hours (hrs). Review of the Treatment Flowsheet dated 07/31/2025 revealed Patient #6’s hemodialysis treatment was initiated at 0745 and ended at 1146 (4 hrs and 1 min). Review of the Flowsheet revealed Patient #6’s BFR average was 360, with no documentation for the decreased BFR and no documentation of the Registered Nurse notification. Review of the Treatment Flowsheet dated 08/02/2025 revealed Patient #6’s hemodialysis treatment was initiated at 0854 and ended at 1135 for a duration of 2 hrs and 44 min (shortened by 76 minutes) with no evidence of an AMA (Against Medical Advice) form completed. Interview on 08/13/2025 at 1500 with the Clinical Manager revealed that the patient care technicians were expected to notify the nursing staff anytime they increased and/or decreased the patient’s BFR, or if they were unable to achieve the ordered BFR. The interview revealed that the nursing staff should have assessed and documented the reason for the decreased BFR during the patient’s treatment. The interview revealed that the facility nursing staff were expected to obtain a signed AMA (Against Medical Advice) form for every patient that received a shortened treatment duration or document the patient’s refusal to sign on the AMA form. 3. Review on 08/13/2025 of the medical record for Patient #4 revealed a 48-year-old male that had been admitted to the facility for in-center hemodialysis (ICHD) treatment on 11/04/2023. A review of the Physician orders revealed Patient #4’s Blood Flow Rate (BFR) was ordered at 450 with a treatment duration order for 4 hours (hrs). Review of the Treatment Flowsheet dated 07/28/2025 revealed Patient #4’s hemodialysis treatment was initiated at 1243 and ended at 1425 (1 hr and 42 min). Review of the Flowsheet revealed Patient #4’s BFR average was 390, with no documentation for the decreased BFR and no documentation of the Registered Nurse notification. Interview on 08/13/2025 at 1500 with the Clinical Manager revealed that the patient care technicians were expected to notify the nursing staff anytime they increased and/or decreased the patient’s BFR, or if they were unable to achieve the ordered BFR. The interview revealed that the nursing staff should have assessed and documented the reason for the decreased BFR during the patient’s treatment. 4. Review on 08/13/2025 of the medical record for Patient #5 revealed a 29-year-old female that had been admitted to the facility for in-center hemodialysis (ICHD) treatment on 04/14/2021. A review of the Physician orders revealed Patient #5’s Blood Flow Rate (BFR) was ordered at 400 with a treatment duration order for 3 hours (hrs) and 45 minutes (min). Review of the Treatment Flowsheet dated 08/07/2025 revealed Patient #5’s hemodialysis treatment was initiated at 1217 and ended at 1522 for a duration of 3 hrs and 5 min (shortened by 40 minutes) with no evidence of an AMA (Against Medical Advice) form completed. Interview on 08/13/2025 at 1500 with the Clinical Manager revealed that the facility nursing staff were expected to obtain a signed AMA (Against Medical Advice) form for every patient that received a shortened treatment duration or document the patient’s refusal to sign on the AMA form. 51294 5. Review on 08/13/2025 of the medical record for Patient #1 revealed a 72-year-old female that had been admitted to the facility for in-center hemodialysis (ICHD) treatment on 04/07/2025. A review of the Physician orders revealed Patient #1’s Blood Flow Rate (BFR) was ordered at 400 with a treatment duration order for 3 hours (hrs) and 30 minutes (min). Review of the Treatment Flowsheet dated 08/01/2025 revealed Patient #1’s hemodialysis treatment was initiated at 1157 and ended at 1543 (3 hr and 46 min). Review of the Flowsheet revealed Patient #1’s BFR average was 330, with no documentation for the decreased BFR and no documentation of the Registered Nurse (RN) notification. Review of the Treatment Flowsheet dated 08/06/2025 revealed Patient #1’s hemodialysis treatment was initiated at 1204 and ended at 1536 (3 hr and 32 min). Review of the Flowsheet revealed Patient #1’s BFR average was 320, with one notation (out of three changes) in regard to decreased BFR (positional) and no documentation of the RN notification. Review of the Treatment Flowsheet dated 08/08/2025 revealed Patient #1’s hemodialysis treatment was initiated at 1202 and ended at 1535 (3 hr and 33 min). Review of the Flowsheet revealed Patient #1’s BFR average was 340, with no documentation for the decreased BFR and no documentation of the RN notification. Interview on 08/13/2025 at 1500 with the Clinical Manager revealed that the patient care technicians were expected to notify the nursing staff anytime they increased and/or decreased the patient’s BFR, or if they were unable to achieve the ordered BFR. The interview revealed that the nursing staff should have assessed and documented the reason for the decreased BFR during the patient’s treatment. Interview on 08/14/2025 at 1255 with the Lead Certified Clinical Hemodialysis Technician (CCHT) revealed that it is expected of staff that they (technicians) would notify the RN if the BFR changed. Interview on 08/14/2025 at 1305 with the RN revealed that “they (technicians) aren’t always telling (the nurse) when the BFR changes” and (the RN) “feels like they bump it down to stop the alarm.” The RN stated that on rounds (the RN) checks the machines to ensure the machines were running at the correct rate and asked the technician if there was a discrepancy. The RN stated that there has been an improvement in RN notification of decrease in BFR but “I think a reminder would be good.” 6. Review on 08/13/2025 of the medical record for Patient #3 revealed an 79-year-old male that had been admitted to the facility for in-center hemodialysis (ICHD) treatment on 08/07/2025. A review of the Physician orders revealed Patient #3’s treatment duration was ordered for 3 hours (hrs) and 30 minutes (min). Review of the Treatment Flowsheet dated 08/07/2025 revealed Patient #3’s hemodialysis treatment was initiated at 1111 and ended at 1354 for a duration of 2 hrs and 42 min (shortened by 48 minutes) with no evidence of an AMA (Against Medical Advice) form completed. Treatment status was listed on the flowsheet as “Completed, Unexpected, Late Arrival with Inability to Extend Treatment.” No further staff documentation was found in the record. Interview on 08/13/2025 at 1500 with the Clinical Manager revealed that the facility nursing staff were expected to obtain a signed AMA form for every patient that received a shortened treatment duration or document the patient’s refusal to sign on the AMA form. The Clinical Manager confirmed that no AMA form could be found in the record for Patient #3.”