Davita Kerr Lake Dialysis

“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: 38766 Based on policy review, medical records review, and staff interview, the facility staff failed to follow the adequacy plan of care by failing to dialyze patients at the prescribed treatment duration time and/or obtain a signed against medical advice (AMA) form for 4 of 6 sampled in-center hemodialysis records(Patients #3, #4, #1, and #5) and by failing to dialyze 1 of 6 patients at the prescribed BFR and DFR (Patient #5). Findings included: a. A review on 10/15/2024 of the policy and procedure “Prescribed Treatment Time no Met” revised 04/2024 revealed “... Policy: A. Completion 0f The Early Termination of Treatment Against Medical Advice Form 1. The RN will verify that a patient signs the Early Termination of Treatment Against Medical Advice Form any time the patient requests to terminate their treatment earlier than the prescribed run time... B. Prescribed treatment Time Not Met ...5. Additionally, if the patient’s dialysis treatment is terminated 30 minutes or more minutes prior to the ordered treatment length, the reason must be documented in the patient electronic health record at the time the treatment was terminated while reconciling the treatment times.” 1. Medical record review on 10/16/2024 for Patient #3 revealed a 57-year-old female admitted to the facility for ICHD treatments on 05/12/2022. The review of the Physician’s dialysis orders revealed the patient’s frequency for ICHD was three times per week for 240 minutes. The review of the treatment sheet dated 09/30/2024 revealed that the patient received dialysis for 179 minutes (61 minutes less than the prescribed 240 minutes). The review of the treatment sheet dated 10/04/2024 revealed that the patient received dialysis for 199 minutes (41 minutes less than the prescribed 240 minutes). The review of the treatment sheet dated 10/07/2024 revealed that the patient received dialysis for 160 minutes (80 minutes less than the prescribed 240 minutes). The review of the treatment sheet dated 10/11/2024 revealed that the patient received dialysis for 206 minutes (34 minutes less than the prescribed 240 minutes). The review revealed no documentation of the rationale for the patient not running the full prescribed treatment time on 09/30/2024, 10/04/2024, 10/07/2024, and 10/11/2024. The review revealed no completed AMA form for early termination of the treatment on 09/30/2024, 10/04/2024, 10/07/2024, and 10/11/2024. An interview on 10/17/24 at 1225 with PCT #3 revealed that the nursing staff was supposed to be notified and the patient presented with an AMA form before every early termination of treatment. The interview revealed that patients should be re-educated each time early termination was requested. An interview on 10/17/2024 at 1453 with the Facility Administrator revealed that any treatment terminated a minute before the prescribed time was considered early termination, and all early termination should require the completion of the AMA form. The interview confirmed that the facility could not locate the forms and confirmed the findings. 2. Medical record review on 10/16/2024 for Patient #4 revealed a 50-year-old male admitted to the facility for ICHD treatments on 01/12/2018. The review of the Physician’s dialysis orders revealed the patient’s frequency for ICHD was three times per week for 255 minutes. The review of the treatment sheet dated 09/30/2024 revealed that the patient received dialysis for 239 minutes (16 minutes less than the prescribed 240 minutes). The review of the treatment sheet dated 10/04/2024 revealed that the patient received dialysis for 240 minutes (15 minutes less than the prescribed 240 minutes). The review revealed no documentation of the rationale for the patient not running the full prescribed treatment time on 09/30/2024 and 10/04/2024. The review revealed no completed AMA form for early termination of the treatment on 09/30/2024 and 10/04/2024. An interview on 10/17/24 at 1225 with PCT #3 revealed that the nursing staff was supposed to be notified and the patient presented with an AMA form before every early termination of treatment. The interview revealed that patients should be re-educated each time early termination was requested. An interview on 10/17/2024 at 1453 revealed that any treatment terminated a minute before the prescribed time was considered early termination, and all early termination should require the completion of the AMA form. The interview confirmed that the facility could not locate the forms and confirmed the findings. 3. Medical record review on 10/15/2024 for Patient #1 revealed a 55-year-old male admitted to the facility for ICHD treatments on 08/29/2018. The review of the Physician’s dialysis orders revealed the patient’s frequency for ICHD was three times per week for 240 minutes. The review of the treatment sheet dated 10/12/2024 revealed that the patient received dialysis for 141 minutes (99 minutes less than the prescribed 240 minutes). The review revealed no documentation of the rationale for the patient not running the full prescribed treatment time on 10/12/2024. The review revealed no completed AMA form for early termination of the treatment on 10/12/2024. An interview on 10/17/24 at 1225 with PCT #3 revealed that the nursing staff was supposed to be notified and the patient presented with an AMA form before every early termination of treatment. The interview revealed that patients should be re-educated each time early termination was requested. An interview on 10/17/2024 at 1453 revealed that any treatment terminated a minute before the prescribed time was considered early termination, and all early termination should require the completion of the AMA form. The interview confirmed that the facility could not locate the forms and confirmed the findings. 4. Medical record review on 10/15/2024 for Patient #5 revealed a 43-year-old male admitted to the facility for ICHD treatments on 04/30/2024. The review of the Physician’s dialysis orders revealed the patient’s frequency for ICHD was three times per week for 240 minutes. The review of the treatment sheet dated 09/30/2024 revealed that the patient received dialysis for 224 minutes (16 minutes less than the prescribed 240 minutes). The review revealed no documentation of the rationale for the patient not running the full prescribed treatment time on 09/30/2024. The review revealed no completed AMA form for early termination of the treatment on 09/30/2024. An interview on 10/17/24 at 1225 with PCT #3 revealed that the nursing staff was supposed to be notified and the patient presented with an AMA form before every early termination of treatment. The interview revealed that patients should be re-educated each time early termination was requested. An interview on 10/17/2024 at 1453 revealed that any treatment terminated a minute before the prescribed time was considered early termination, and all early termination should require the completion of the AMA form. The interview confirmed that the facility could not locate the forms and confirmed the findings. b. Review on 10/15/2024 of the facility policy titled “Pre-Intra-Post Treatment Data Collection, Monitoring, And Nursing Assessment” revised April 2021 revealed, “...Intradialytic Data Collection/Assessment ...10. If the dialysis prescription is not being met (including dialysis flow rate or change to /inability to obtain prescribed blood flow rate) the reason will be documented and the licensed nurse informed...” Medical record review on 10/15/2024 for Patient #5 revealed a 43-year-old male admitted to the facility for ICHD treatments on 04/30/2024. The review of the Physician’s dialysis orders revealed Patient #5’s Blood Flow Rate (BFR) was ordered at 400 and Dialysate Flow Rate (DFR) at 800. A review of the Treatment Flowsheet dated 09/30/2024 revealed Patient #5’s hemodialysis treatment was initiated at 1201 and ended at 1545. A review of the Flowsheet revealed Patient #5’s BFR average was 350 and DFR average was 800 with no documentation for the decreased BFR and no documentation of the Registered Nurse notification. A review of the Treatment Flowsheet dated 10/09/2024 revealed Patient #5’s hemodialysis treatment was initiated at 1054 and ended at 1500. The review of the Flowsheet revealed Patient #5’s BFR average was 380 and DFR average was 500 with no documentation for the decreased BFR and DFR and no documentation of the Registered Nurse notification. A review of the Treatment Flowsheet dated 10/11/2024 revealed Patient #5’s hemodialysis treatment was initiated at 1107 and ended at 1439. The review of the Flowsheet revealed Patient #5’s BFR average was 294 and DFR average was 800 with no documentation for the decreased BFR and no documentation of the Registered Nurse notification. An interview on 10/17/2024 at 1453 with the Facility Administrator revealed that PCTs should notify the nursing staff anytime they increased and/or decreased the patient’s BFR/DFR or were unable to achieve the ordered BFR/DFR. The interview revealed that the nursing staff should have assessed and documented after the PCTs the reason for the decreased BFR/DFR during the patient’s treatment. The interview confirmed the findings that patient #5 had a decreased BFR in 3 of 6 treatments and a decreased DFR in 1 of 6 treatments with no documentation for the decreased BFR/DFR and Registered Nurse notification.”

“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 medical record review, training handout review, and staff interviews, the facility staff failed to ensure a patient recorded treatment data as prescribed on the treatment sheets for 1 of 3 PD patients (Patient #9) A review of a training handout titled “Measuring Your Health at Home” revealed, “...Track and record your vital signs every day. The information you record will help you and your healthcare team know how well you are responding to dialysis treatment and if changes need to be made. These are the vitals you will track each day: Blood Pressure... weight...” An open medical record review on 10/17/2024 for Patient #9 revealed the patient was admitted to the home PD program on 07/07/2023. Order review revealed that the patient was prescribed once-a-day treatment. A review of the treatment flow sheets between 08/04/2024 and 10/14/2024 revealed no documented pre-treatment weight on August 20th, 27th, 29th, September 5th, 6th, 9th, 11th, 14th, 16th, 17th, 18th, 20th, 21st, 22nd, 24th, 25th, 26th, 30th, October 1st, 2nd, 4th, 5th, 6th, 7th, 8th, 12th, and 13th. The treatment flow sheets between 08/04/2024 and 10/14/2024 revealed no documented of blood pressure on August 5th, 6th, 19th, 20th, 27th, 29th, September 5th, 6th, 9th, 10th, 11th, 12th, 13th, 14th, 16th, 17th, 18th, 20th, 21st, 22nd, 24th, 25th, 26th, 30th, October 1st, 2nd, 4th, 6th, 7th, 8th, 9th, 10th, 12th, 13th, and 14th. The review revealed no evidence that reeducation was provided by the registered nurse to Patient #9 on the reasons for patients to document daily weight and blood pressure before each treatment. An interview on 10/17/2024 at 1315 with a PD training nurse revealed that the patient skipped the BP and weight at times. The nurse had reeducated the patient that the weight and blood pressure were required data. The nurse added that “the reeducation may not have always been documented.” An interview on 10/17/2024 at 1635 with the Home Program Manager revealed that the patients were educated on the data that was supposed to be documented on the flowsheet including daily weight and blood pressure. The interview revealed if data was missing on the flowsheet, the expectation was for the staff to reeducate the patient and document all reeducation in the patient’s record. NC00211952”