Fmc New Hope Dialysis

“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 on patients during dialysis treatments for 4 (four) of 9 (nine) in-patient records reviewed (Patient #12, #5, #1, and #6). Findings included: A review on 06/11/2024 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 06/12/2024 for Patient #12 revealed a 44-year-old female was admitted to the facility for ICHD treatments on 01/31/2023. A review of the treatment sheet dated 06/06/2024 revealed the treatment started at 1100 and ended at 1503 (243 minutes). The treatment flowsheet revealed no documented vital signs from 1101 through 1233 (92 minutes). The review revealed the facility staff failed to monitor the patient every 30 to 45 minutes during the hemodialysis treatment. An interview on 06/13/2024 at 1400 with PCT #1 revealed safety monitoring including the patient’s vital signs, should be performed and documented at least every 30 minutes. An interview on 06/13/2024 at 1430 with the Charge Nurse revealed that the staff was responsible for monitoring and documenting the patient’s blood pressure and pulse every 30 to 45 minutes or more frequently as needed. The interview confirmed that the staff did not follow the policy. 2. An open medical record review on 06/11/2024 for Patient #5 revealed a 43-year-old female was admitted to the facility for ICHD treatments on 01/20/2015. A review of the treatment sheet dated 06/05/2024 revealed the treatment started at 0624 and ended at 1024 (240 minutes). The treatment flowsheet revealed no documented vital signs from 0903 through 1029 (86 minutes). A review of the treatment flowsheet dated 06/07/2024 revealed the treatment started at 0625 and ended at 1011 (226 minutes). The treatment flowsheet revealed no documented vital signs from 0656 through 0756 (60 minutes). The review revealed the facility staff failed to monitor the patient every 30 to 45 minutes during the hemodialysis treatment. An interview on 06/13/2024 at 1400 with PCT #1 revealed safety monitoring including the patient’s vital signs, should be performed and documented at least every 30 minutes. An interview on 06/13/2024 at 1430 with the Charge Nurse revealed that the staff was responsible for monitoring and documenting the patient’s blood pressure and pulse every 30 to 45 minutes or more frequently as needed. The interview confirmed that the staff did not follow the policy. 3. An open medical record review on 06/12/2024 for Patient #1 revealed a 66-year-old male was admitted to the facility for ICHD treatments on 03/21/2024. A review of the treatment sheet dated 06/05/2024 revealed the treatment started at 1207 and ended at 1609 (242 minutes). The treatment flowsheet revealed no documented vital signs from 1403 through 1500 (57 minutes). The review revealed the facility staff failed to monitor the patient every 30 to 45 minutes during the hemodialysis treatment. An interview on 06/13/2024 at 1400 with PCT #1 revealed safety monitoring including the patient’s vital signs, should be performed and documented at least every 30 minutes. An interview on 06/13/2024 at 1430 with the Charge Nurse revealed that the staff was responsible for monitoring and documenting the patient’s blood pressure and pulse every 30 to 45 minutes or more frequently as needed. The interview confirmed that the staff did not follow the policy. 4. An open medical record review on 06/12/2024 for Patient #6 revealed a 75-year-old male was admitted to the facility for ICHD treatments on 11/13/2013. A review of the treatment sheet dated 06/06/2024 revealed the treatment started at 1059 and ended at 1501 (241 minutes). The treatment flowsheet revealed no documented vital signs from 1407 through 1503 (57 minutes) two minutes after the treatment ended. The review revealed the facility staff failed to monitor the patient every 30 to 45 minutes during the hemodialysis treatment. An interview on 06/13/2024 at 1400 with PCT #1 revealed safety monitoring including the patient’s vital signs, should be performed and documented at least every 30 minutes. An interview on 06/13/2024 at 1430 with the Charge Nurse revealed that the staff was responsible for monitoring and documenting the patient’s blood pressure and pulse every 30 to 45 minutes or more frequently as needed. The interview confirmed that the staff did not follow the policy.”

“POC-VA MONITOR/PREVENT FAILURE/STENOSIS CFR(s): 494.90(a)(5) The patient’s vascular access must be monitored to prevent access failure, including monitoring of arteriovenous grafts and fistulae for symptoms of stenosis. This Standard is not met as evidenced by: 38766 Based on policies and procedures review, observations, and staff interviews, the facility staff failed to follow the facility policy in cannulating an AVF/G (Arteriovenous Fistula/Graft) in 1 of 3 observations (PCT #12). Findings included: A review of the facility’s current policy “Access assessment and Cannulation” revised 05/06/2024 revealed, “... Policy Evaluation and preparation of the access will be performed routinely prior to cannulation at each dialysis session. A tourniquet must be used with an AV Fistula... Assessment of Vascular access ...6. Listen ...Note: Staff /patients/care partners who have trained to auscultate vascular accesses should listen to the entire length of the access for changes in the sound of the bruit - a normal low-pitched bruit should be present...” An observation on 06/11/2024 at 1125 revealed PCT #2 entered station #25 to initiate dialysis with an AVF/G for Patient #12. The observation revealed PCT #2 cleaned the access site with alcohol, palpated the access to evaluate the access, performed hand hygiene, changed gloves, and proceeded directly to cannulation. The observation revealed PCT #2 failed to listen to the access with a stethoscope and apply a tourniquet above the access site before cannulation. An open medical record review on 06/12/2024 for Patient #12 revealed a 44-year-old female was admitted to the facility for ICHD treatments on 01/31/2023. The record review of Patient #12’s treatment orders written on 05/30/2024 revealed that Patient #12 was being dialyzed via an arteriovenous fistula. An interview on 06/11/2024 at 1130 with PCT #2 during the unit observation revealed that the patient had a fistula. The interview revealed that PCT #2 did not need a tourniquet because “I could feel the fistula.” The interview revealed, “If I can feel the fistula, the use of a stethoscope and tourniquet was not necessary.” An interview on 06/13/2024 at 1430 with the Charge Nurse revealed that the expectation was for the staff to check the treatment order before cannulating a patient, listen to all accesses, and use a tourniquet for all cannulation of a fistula. The interview revealed that all staff had been educated on the policy.”

“H-FAC RECEIVE/REVIEW PT RECORDS Q 2 MONTHS CFR(s): 494.100(b)(2),(3) The dialysis facility must - (2) Retrieve and review complete self-monitoring data and other information from self-care patients or their designated caregiver(s) at least every 2 months; and (3) Maintain this information in the patient ’ s medical record. This Standard is not met as evidenced by: 38766 Based on facility policy review, medical records review, and staff interviews, the facility’s home program staff failed to follow the facility’s policy for the review and patient education of home treatment flowsheet data for 3 of 4 home therapy medical records reviewed (Patient #2 and #11). Findings included: A review on 06/11/2024 of the facility’s policy, “Review and Documentation of Home Therapies Patient Health Data” published 05/01/23 revealed that “...Review and Documentation of Health Data At a minimum, the home therapies nurse will perform a comprehensive monthly review of all treatment dates, regardless of the method of data submission. Data review will be discussed with the patient and care partner during the patient’s regular clinic visit and concerns will be addressed and documented accordingly ...” 1. An open medical record review on 06/11/2024 for Patient #2 revealed the patient was admitted to the home hemodialysis program on 10/12/2018. The review of the treatment orders written on 03/01/2024 revealed an estimated treatment time of 4 hours and 0 minutes (240 minutes) 4 times a week. A review of the treatment flow sheets between 03/01/2024 and 05/01/2024 revealed no documented pre-treatment weight on 04/09/2024 and no documented Post-treatment weight on 03/02/2024, 03/18/2024, and 04/03/2024. The review revealed no documented pre-treatment blood pressure on 03/18/2024, 03/24/2024, 04/09/2024, 04/30/2024, and no post-treatment blood pressure on 03/02/2024, 03/12/2024, 03/18/2024, 03/21/2024, 03/23/2024, 03/24/2024, and 04/01/2024. The review revealed that the documented treatment of 123 minutes on 03/12/2024, 136 minutes on 03/13/2024, 211 minutes on 03/15/2024, 131 minutes on 03/18/2024, 156 minutes on 03/21/2024, and 183 minutes on 04/40/2024. The record review revealed no evidence that re-education was provided by the registered nurse to Patient #2 on the missing data and shortened treatment duration. An interview on 06/13/2024 at 1300 with the Home Training Program Manager revealed that the nurses were responsible for reviewing the patient’s data every month during clinic visits and re-educating the patients on any data outside the normal limits. The manager added that when data was missing, the expectation was for the nurses to remind the patients of their responsibilities to the home program and to document the reminders in the patient’s records. The interview confirmed that the nurses failed to follow the facility. 2. An open medical record review on 06/13/2024 for Patient #11 revealed that the patient was admitted to the home hemodialysis program on 08/10/2020. The review of the treatment orders written on 11/30/2023 revealed an estimated treatment time of 2 hours and 30 minutes (150 minutes) 4 times a week. A review of the treatment flow sheets between 03/01/2024 and 05/01/2024 revealed no documented Post-treatment weight on 03/03/2024, 03/15/2024, 03/18/2024, 03/22/2024, 03/28/2024, 03/29/2024, and 04/17/2024, and no post-treatment blood pressure on 03/15/2024, 03/18/2024, 03/22/2024, 03/28/2024, and 03/29/2024. The treatment record review revealed only ten (10) treatments documented for April 2024. The record review revealed no evidence that the nurses re-educated Patient #11 on the missing data and treatments. An interview on 06/13/2024 at 1300 with the Home Training Program Manager revealed that the nurses were responsible for reviewing the patient’s data every month during clinic visits and re-educating the patients on any data outside the normal limits. The manager added that when data was missing, the expectation was for the nurses to remind the patients of their responsibilities to the home program and to document the reminders in the patient’s records. The interview confirmed that the nurses failed to follow the facility.”