Fmc Bma of Zebulon Inc.

“PA-APPROPRIATENESS OF DIALYSIS RX CFR(s): 494.80(a)(2) The patient’s comprehensive assessment must include, but is not limited to, the following: (2) Evaluation of the appropriateness of the dialysis prescription, This Standard is not met as evidenced by: 38766 Based on review of policy and procedure, medical records and staff interviews, the facility staff failed to perform dialysis treatments as prescribed in 4 of 10 sampled hemodialysis patients treatment sheets reviewed (Patient #3, #4, #6, and #8) Findings included: Review on 03/12/2024 of the facility’s policy titled, “Patient Assessment and Monitoring” revised 05/01/2023 revealed “...During Treatment... 3. Machine Parameters and Extracorporeal Circuit 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. Check dialysate flow rate setting is correct, and the prescribed flow is being delivered...” 1. Medical record review on 03/12/2024 for Patient #3’s treatment sheet dated 02/27/2024 revealed a prescription for a BFR of 425 mL/min (milliliters per minute) and a DFR of 800 ml/min. Review revealed the patient received an HD treatment from 0639 through 1008 with a BFR of 350 ml/min and a DFR of 500 ml/min. Review revealed no documented rationale for the reduced BFR and DFR, or notification of the Registered Nurse (RN). Review revealed on 02/29/2024 a prescription for a BFR of 425 mL/min and a DFR of 800 ml/min. Review revealed the patient received an HD treatment from 0631 through 1032 with a BFR of 360 and a DFR of 800. Review revealed no documented rationale for the reduced BFR, or notification of the RN. Interview on 03/14/2024 at 0900 with PCT #1, revealed documentation to include verification of the physician orders, and machine parameters were to be verified every 30 minutes on every patient receiving hemodialysis. Interview revealed the nurse was to be notified of any out-of-range findings. Interview on 03/14/2024 at 1325 with the CN revealed the PCTs were expected to monitor patient’s ordered BFR and DFR during safety checks and to notify the nurses if the BFR or DFR were not met. Interview confirmed that the policy and procedures were not followed. 2. Medical record review on 03/12/2024 for Patient #4’s treatment sheet dated 02/27/2024 revealed a prescription for a BFR of 450 mL/min (milliliters per minute) and a DFR of Autoflow 2.0 (2 times the BFR). Review revealed the patient received an HD treatment from 1204 through 1657 with a BFR of 450 ml/min and a DFR of 640 ml/min. Review revealed no documented rationale for the reduced DFR, or notification of the RN. Interview on 03/14/2024 at 0900 with PCT #1, revealed documentation to include verification of the physician orders, and machine parameters were to be verified every 30 minutes on every patient receiving hemodialysis. Interview revealed the nurse was to be notified of any out of range findings. Interview on 03/14/2024 at 1325 with the CN revealed the PCTs were expected to monitor patient’s ordered BFR and DFR during safety checks and to notify the nurses if the BFR or DFR were not met. Interview confirmed that the policy and procedures were not followed. 3. Medical record review on 03/12/2024 for Patient #6’s treatment sheet dated 02/26/2024 revealed a prescription for a BFR of 400 mL/min (milliliters per minute) and a DFR of 800 ml/min. Review revealed the patient received an HD treatment from 1029 through 1422 with a BFR of 320 ml/min and a DFR of 800 ml/min. Review revealed no documented rationale for the reduced BFR, or notification of the RN. Review revealed on 02/28/2024 a prescription for a BFR of 400 mL/min and a DFR of 800 ml/min. Review revealed the patient received an HD treatment from 1020 through 1420 with a BFR of 380 and a DFR of 700. Review revealed no documented rationale for the reduced BFR and DFR, or notification of the RN. Review revealed on 03/01/2024 a prescription for a BFR of 400 mL/min and a DFR of 800 ml/min. Review revealed the patient received an HD treatment from 1112 through 1426 with a BFR of 300 and a DFR of 600. Review revealed no documented rationale for the reduced BFR, or notification of the RN. Interview on 03/14/2024 at 0900 with PCT #1, revealed documentation to include verification of the physician orders, and machine parameters were to be verified every 30 minutes on every patient receiving hemodialysis. Interview revealed the nurse was to be notified of any out-of-range findings. Interview on 03/14/2024 at 1325 with the CN revealed the PCTs were expected to monitor patient’s ordered BFR and DFR during safety checks and to notify the nurses if the BFR or DFR were not met. Interview confirmed that the policy and procedures were not followed. 4. Medical record review on 03/12/2024 for Patient #8’s treatment sheet dated 02/28/2024 revealed a prescription for a BFR of 450 mL/min (milliliters per minute) and a DFR of Autoflow 2.0 (2 times the BFR). Review revealed the patient received an HD treatment from 1218 through 1705 with a BFR of 360 ml/min and a DFR of 600 ml/min. Review revealed no documented rationale for the reduced BFR and DFR, or notification of the RN. Interview on 03/14/2024 at 0900 with PCT #1, revealed documentation to include verification of the physician orders, and machine parameters were to be verified every 30 minutes on every patient receiving hemodialysis. Interview revealed the nurse was to be notified of any out-of-range findings. Interview on 03/14/2024 at 1325 with the CN revealed the PCTs were expected to monitor patient’s ordered BFR and DFR during safety checks and to notify the nurses if the BFR or DFR were not met. Interview confirmed that the policy and procedures were not followed.”

“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, and staff interviews, the facility staff failed to perform and/or document every 30-minute monitoring on patients during dialysis treatments for 4 of 10 patients reviewed. (Patient #8, #1, #3, and #4). Findings included: Review on 03/12/2024 of the facility’s policy titled, “Patient Assessment and Monitoring” revised 05/01/2023 revealed “...During Treatment Obtain 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. Medical record review on 03/12/2024 of Patient #8 revealed a 40-year-old male patient admitted to the facility on 12/09/2019. Review of the patient’s “Post Treatment” (Dialysis treatment flowsheets) for 02/26/2024 revealed a treatment duration of 288 minutes. The treatment flowsheet revealed no documented vital signs from 1336 through 1430 (54 minutes later) and from 1601 through 1709 (68 minutes). Review of the treatment flowsheet for 02/28/2024 revealed a treatment duration of 287 minutes. The treatment flowsheet revealed no documented vital signs from 1230 through 1334 (64 minutes). Review of the treatment flowsheet for 03/01/2024 revealed a treatment duration of 289 minutes. The treatment flowsheet revealed no documented vital signs from 1309 through 1432 (83 minutes). Review of the treatment flowsheet for 03/04/2024 revealed a treatment duration of 289 minutes. The treatment flowsheet revealed no documented vital signs from 1220 through 1335 (65 minutes) and from 1507 through 1305 (58 minutes) and from 1605 through 1705 (60 minutes). Review revealed the facility staff failed to monitor the patient every 30 minutes during the hemodialysis treatment. Interview on 03/14/2024 at 0900 with PCT #1, revealed safety checks including vital signs should be documented every 30 minutes and as needed if a patient was unstable. Interview on 03/14/2024 at 1325 with the CN revealed vital signs and safety checks should be done every 30 minutes or more frequently if needed to include if a patient was symptomatic or experiencing low blood pressure or elevated pulse. Interview confirmed that the policy and procedures were not followed. 2. Medical record review on 03/12/2024 of Patient #1 revealed a 57-year-old male patient admitted to the facility on 11/15/2010. Review of the patient’s treatment flowsheets for 03/02/2024 revealed a treatment duration of 240 minutes. The treatment flowsheet revealed no documented vital signs from 0702 through 0807 (65 minutes). Review of the treatment flowsheets for 03/07/2024 revealed a treatment duration of 241 minutes. The treatment flowsheet revealed no documented vital signs from 0829 through 0930 (61 minutes). Review revealed the facility staff failed to monitor the patient every 30 minutes during the hemodialysis treatment. Interview on 03/14/2024 at 0900 with PCT #1, revealed safety checks including vital signs should be documented every 30 minutes and as needed if a patient was unstable. Interview on 03/14/2024 at 1325 with the CN revealed vital signs and safety checks should be done every 30 minutes or more frequently if needed to include if a patient was symptomatic or experiencing low blood pressure or elevated pulse. Interview confirmed that the policy and procedures were not followed. 3. Medical record review on 03/12/2024 of Patient #3 revealed a 71-year-old female patient admitted to the facility on 12/21/2023. Review of the patient’s treatment flowsheets for 02/29/2024 revealed a treatment duration of 241 minutes. The treatment flowsheet revealed no documented vital signs from 0900 through 1000 (60 minutes). Review revealed the facility staff failed to monitor the patient every 30 minutes during the hemodialysis treatment. Interview on 03/14/2024 at 0900 with PCT #1, revealed safety checks including vital signs should be documented every 30 minutes and as needed if a patient was unstable. Interview on 03/14/2024 at 1325 with the CN revealed vital signs and safety checks should be done every 30 minutes or more frequently if needed to include if a patient was symptomatic or experiencing low blood pressure or elevated pulse. Interview confirmed that the policy and procedures were not followed. 4. Medical record review on 03/12/2024 of Patient #4 revealed a 42-year-old female patient admitted to the facility on 06/30/2022. Review of the patient’s treatment flowsheets for 03/05/2024 revealed a treatment duration of 252 minutes. The treatment flowsheet revealed no documented vital signs from 1500 through 1600 (60 minutes). Review revealed the facility staff failed to monitor the patient every 30 minutes during the hemodialysis treatment. Interview on 03/14/2024 at 0900 with PCT #1, revealed safety checks including vital signs should be documented every 30 minutes and as needed if a patient was unstable. Interview on 03/14/2024 at 1325 with the CN revealed vital signs and safety checks should be done every 30 minutes or more frequently if needed to include if a patient was symptomatic or experiencing low blood pressure or elevated pulse. Interview confirmed that the policy and procedures were not followed.”

“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 record review, and staff interviews, the facility’s IDT members failed to perform a monthly reassessment or revision and consider a patient as unstable for 1 of 1 sampled patient after an extended hospitalization (Patient #5). Findings included: A review on 03/13/2024 of the facility’s policy titled, “Comprehensive Interdisciplinary Assessment and Plan of Care” revised 07/30/2023 revealed “...CIA/POC for Unstable Patients Unstable patients must be reassessed by the IDT monthly. Monthly reassessment and any POC updates related to the reason 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 03/12/2024 of Patient #5 revealed the patient was admitted to the facility on 12/21/2022 for in-center hemodialysis treatment. A review of the record revealed the patient was admitted to the hospital on 11/01/2023 through 11/27/2023 (26 days) for right foot dry gangrene and underwent a right transmetatarsal amputation. Review revealed the patient’s previous plan of care was an annual plan of care on 02/17/2023 with documentation that the patient was “stable”. Review revealed the next annual plan of care meeting was conducted on 02/13/2024. No documentation was found that any monthly reassessments or revisions of the plan of care were done considering the patient as unstable by the IDT after the hospitalization. Interview on 03/13/2024 at 1325 with the CN revealed based on the length of the hospitalization and the amputation, Patient #5 should have been made unstable and been reassessed monthly. Follow-up interview on 03/14/2024 at 1325 with the CN revealed the clinic utilized the POC Dashboard (computer program) to determined unstable patients after hospitalization. Interview revealed in addition to the dashboard, the CN would review the hospital record for any deteriorated status during the hospitalization. Interview on 03/14/2024 at 1400 with the Director of Operation revealed the computer and the CN failed to identify the patient as unstable after the hospitalization because the patient received dialysis treatment at another clinic for 3 weeks while receiving outpatient physical therapy. The interview revealed the patient was never discharged therefore the clinic was responsible for reassessing the patient upon his return. Interview confirmed that the policy and procedures were not followed.”