Fmc Bma of Crystal Coast Inc.

“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: 38766 Based on a review of policy and procedures, medical records review, and staff interviews, the facility staff failed to perform and/or document every 30-45-minute monitoring of patients during dialysis treatments for 4 (four) of 8 (eight) in-patient records reviewed (Patient #2, #7, #4, and #3). Findings included: A review on 09/10/2024 of the facility’s policy and procedure, “Patient Assessment and Monitoring” published 05/01/2023, revealed “...During Treatment Obtaining blood pressure and pulse rate every 30 minutes or more as needed but not to exceed 45 minutes or per state regulations. Document machine parameters and safety checks every 30 minutes or more often as needed but not to exceed 45 minutes per state regulations...” 1. An open medical record review on 09/10/2024 for Patient #2 revealed a 70-year-old female was admitted to the facility for ICHD treatments on 10/13/2023. A review of the treatment sheet dated 09/04/2024 revealed the treatment started at 1153 and ended at 1540 (227 minutes). The treatment flowsheet revealed no documented vital signs from 1307 through 1432 (85 minutes). A review of the treatment flowsheet dated 09/06/2024 revealed the treatment started at 1138 and ended at 1548 (250 minutes). The treatment flowsheet revealed no documented vital signs from 1303 through 1405 (62 minutes). The review revealed the facility staff failed to monitor the patient every 30 to 45 minutes during the hemodialysis treatment per the facility policy. An interview on 09/12/2024 at 0930 with RN #2 revealed that the patient’s vital signs and safety checks should be done every 30 minutes by the PCTs. The interview revealed the PCTs were expected to notify the nurse of any abnormal findings. The interview confirmed that the staff did not follow the policy. 2. An open medical record review on 09/12/2024 for Patient #7 revealed a 48-year-old male was admitted to the facility for ICHD treatments on 07/05/2022. A review of the treatment sheet dated 09/03/2024 revealed the treatment started at 1154 and ended at 1602 (248 minutes). The treatment flowsheet revealed no documented vital signs from 1447 through 1605 (78 minutes). The review revealed the facility staff failed to monitor the patient every 30 to 45 minutes during the hemodialysis treatment per the facility policy. An interview on 09/12/2024 at 0930 with RN #2 revealed that the patient’s vital signs and safety checks should be done every 30 minutes by the PCTs. The interview revealed the PCTs were expected to notify the nurse of any abnormal findings. The interview confirmed that the staff did not follow the policy. 3. An open medical record review on 09/11/2024 for Patient #4 revealed a 69-year-old female was admitted to the facility for ICHD treatments on 01/30/2019. A review of the treatment sheet dated 09/04/2024 revealed the treatment started at 1116 and ended at 1507 (241 minutes). The treatment flowsheet revealed no documented vital signs from 1331 through 1438 (67 minutes). A review of the treatment sheet dated 09/06/2024 revealed the treatment started at 1125 and ended at 1523 (235 minutes).(Would this be 238 minutes? Double check my math...) The treatment flowsheet revealed no documented vital signs from 1435 through 1523 (52 minutes). The review revealed the facility staff failed to monitor the patient every 30 to 45 minutes during the hemodialysis treatment per the facility policy. An interview on 09/12/2024 at 0930 with RN #2 revealed that the patient’s vital signs and safety checks should be done every 30 minutes by the PCTs. The interview revealed the PCTs were expected to notify the nurse of any abnormal findings. The interview confirmed that the staff did not follow the policy. 4. An open medical record review on 09/11/2024 for Patient #3 revealed a 79-year-old male was admitted to the facility for ICHD treatments on 07/29/2023. A review of the treatment sheet dated 09/03/2024 revealed the treatment started at 0945 and ended at 1415 (270 minutes). The treatment flowsheet revealed no documented vital signs from 1400 through 1505 (65 minutes). The review revealed the facility staff failed to monitor the patient every 30 to 45 minutes during the hemodialysis treatment per the facility policy. An interview on 09/12/2024 at 0930 with RN #2 revealed that the patient’s vital signs and safety checks should be done every 30 minutes by the PCTs. The interview revealed the PCTs were expected to notify the nurse of any abnormal findings. The interview confirmed that the staff did not follow the policy.”

“PA-FREQUENCY REASSESSMENT-UNSTABLE Q MO CFR(s): 494.80(d)(2) In accordance with the standards specified in paragraphs (a)(1) through (a)(13) of this section, a comprehensive reassessment of each patient and a revision of the plan of care must be conducted- At least monthly for unstable patients including, but not limited to, patients with the following: (i) Extended or frequent hospitalizations; (ii) Marked deterioration in health status; (iii) Significant change in psychosocial needs; or (iv) Concurrent poor nutritional status, unmanaged anemia and inadequate dialysis. This Standard is not met as evidenced by: 38766 Based on policies and procedures review, medical records review, and staff interviews, the facility’s IDT members failed to identify a patient as unstable and perform a monthly reassessment and plan-of-care for 1 of 1 sampled patient after an extended hospitalization (Patient #2). Findings included A review on 09/10/2024 of the facility’s policy titled, “Comprehensive Interdisciplinary Assessment and Plan of Care” revised 07/03/2023 revealed “...CIA/POC for Unstable Patients: Unstable patients must be reassessed by the IDT monthly. Monthly reassessment and any POC updates related to why the patient is considered ‘unstable’ must be documented until the issues have been resolved or the IDT (including the patient, if possible) determines that the condition is chronic. The following are unstable criteria: a. Hospitalization of more than 15 days with discharge occurring within the last 30 days. ...” Medical record review on 09/10/2024 of Patient #2 revealed the patient was admitted to the facility on 10/13/2023 for in-center hemodialysis treatment. A review of the record revealed the patient was admitted to the hospital on 10/25/2023 (12 days after admission) through 01/12/2024 (79 days hospital stay) with an admitting diagnosis of “Psychiatric Disorder.” On 02/15/2024, the patient’s initial plan of care was conducted and documented, and the patient’s “Current Stability Status: N/A” and an “Interval Next Meeting: 90 days”. On 05/08/2024, the patient had a 90-day plan of care that was conducted and documented that the patient’s “Current Stability Status: N/A” and an “Interval Next Meeting: 365 days.” The review revealed no documentation that a monthly reassessment or revisions of a plan of care was done to consider the patient as unstable by the IDT after a hospitalization of a 79-day stay. An interview on 09/11/2024 at 0945 revealed that the patient was admitted to the facility, and ten days later, the patient experienced a complete psychiatric breakdown. During that time, the patient was loud and tearful during treatment. The nurse had to send the patient to the hospital for evaluation. The interview revealed that the patient was kept in the hospital for almost 80 days while the hospital attempted to find placement in a psychiatric center that could also provide hemodialysis treatments. The hospital could not find such a facility, and the hospital eventually sent the patient home with home care. The interview revealed, “I don’t know why we (the IDT team) did not make her unstable.” The interview confirmed the findings.”

“POC-VASCULAR ACCESS-MONITOR/REFERRALS CFR(s): 494.90(a)(5) The interdisciplinary team must provide vascular access monitoring and appropriate, timely referrals to achieve and sustain vascular access. The hemodialysis patient must be evaluated for the appropriate vascular access type, taking into consideration co-morbid conditions, other risk factors, and whether the patient is a potential candidate for arteriovenous fistula placement. This Standard is not met as evidenced by: 38766 Based on policy and procedure review, observations, and staff interviews, the facility failed to ensure staff performed skin antisepsis per policy before cannulation of 1 of 3 patients Arterio-venous fistula/graft (AVF/AVG) cannulation procedures observed (Station #7, PCT #1). Findings included: A review on 09/10/2024 of the facility policy titled “Access Assessment and Cannulation” published 05/06/2024 revealed, “...Skin Disinfection ...2. Perform skin antisepsis on one site at a time, allow to dry and then cannulate. Do not touch cannulation sites after skin disinfection. Note: This method minimizes the risk of contaminating the second site while cannulating the first site...” Observation on 09/10/2024 at 1210 in the patient treatment area revealed PCT #1 entered Station #7 and initiated access of an Arterio-venous fistula/graft (AVF/G) for hemodialysis treatment. PCT #1 performed hand hygiene and applied clean gloves. PCT #1 cleansed the arterial access site with a 70% isopropyl alcohol pad for 30 seconds. PCT #1 allowed the patient to touch the cannulation site to indicate where to insert the arterial needle. Observation revealed PCT #1 failed to disinfect the access site per the facility policy. An interview on 09/10/2024 at 1240 with PCT #1 revealed that the cannulation site should not be touched between disinfection and cannulation. The interview revealed that PCT #1 forgot to disinfect the cannulation site after the patient felt it to indicate the site for cannulation. The interview revealed that the staff had failed to follow the facility policy. An interview on 09/12/2024 at 0930 with RN #2 revealed the staff were expected to adhere to the skin disinfection policy by not touching the site after skin disinfection. The Interview revealed the staff failed to follow the policy.”