Davita Fargo Dialysis Center

“IC-WEAR GLOVES/HAND HYGIENE CFR(s): 494.30(a)(1) Wear disposable gloves when caring for the patient or touching the patient’s equipment at the dialysis station. Staff must remove gloves and wash hands between each patient or station. This Standard is not met as evidenced by: 19410 Based on policy review, observation, and staff interview, the facility failed to ensure staff followed infection control precautions for 3 of 5 patients (Patient #9, #10, and #11) observed during initiation/discontinuation of hemodialysis with an arteriovenous fistula/central venous catheter (CVC) and during exit site care of a CVC. Failure to follow infection control guidelines placed patients and staff members at risk for infection due to cross-contamination. Findings include: Review of the policy “Infection Control for Dialysis Facilities” occurred on 08/06/24. This policy, revised April 2023, stated, “. . . Hand Hygiene 1. All teammates . . . will perform hand hygiene . . . b. prior to gloving and immediately after removal of gloves, c. after contamination with blood or other infectious material, . . . g. before touching clean areas such as supplies, supply cart and chairside keyboard/mouse . . .” - Observation on 08/05/24 at 11:18 a.m. showed a staff member (#3) entered Station #3 to initiate dialysis with a CVC and to perform CVC exit site care for Patient #9. After entering the station, the staff member (#3) removed their gloves and without performing hand hygiene, donned a new pair of gloves and placed a clean field under the CVC ports. After removing the old dressing during exit site care, the staff member (#3) removed their gloves and without performing hand hygiene, donned a new pair of gloves. - Observation on 08/05/24 at 2:02 p.m. showed a staff member (#3) entered Station #2 to discontinue dialysis with a fistula for Patient #10. After entering the station, the staff member (#3) touched a biohazard waste container and moved it closer to the patient. Without changing gloves, the staff member (#3) removed the patient’s needles to discontinue treatment. - Observation on 08/05/24 at 3:10 p.m. showed a staff member (#3) in Station #12 to discontinue dialysis with a CVC for Patient #11. The staff member (#3) adjusted the patient’s blood pressure cuff and entered data into the computer. Without changing gloves, the staff member disconnected the patient’s blood-tubing line from the central venous catheter. During interview on 08/07/24 at 9:35 a.m., an administrative staff member (#4) confirmed staff should perform hand hygiene after removing gloves and before donning new gloves and should change gloves after touching potentially contaminated surfaces. 20497”

“PE-HD PTS IN VIEW DURING TREATMENTS CFR(s): 494.60(c)(4) Patients must be in view of staff during hemodialysis treatment to ensure patient safety, (video surveillance will not meet this requirement). This Standard is not met as evidenced by: 20497 Based on observation, policy review, and staff interview, the facility failed to ensure visible access sites during hemodialysis treatments for 2 of 12 patients (Patients #12 and #13) observed during the second shift on 08/05/24. Failure to ensure patients’ access sites remained uncovered and visible to staff limited the staff’s ability to promptly detect accidental needle dislodgements. Findings include: Review of the policy “Pre-Intra-Post Treatment Data Collection, Monitoring, and Nursing Assessment” occurred on 08/06/24. This policy, revised April 2024, stated, “. . . Intradialytic Data Collection Assessment . . . 9. Intradialytic treatment monitoring . . . includes: . . . c. The vascular access site, blood line connections and the patient’s face should be visible throughout the dialysis treatment. . . .” Observations on 08/05/24 during the second shift showed the following patients’ access sites covered with blankets: - Patient #12 at 12:55 p.m. in Station #6. A staff member (#5) uncovered the access site when prompted. - Patient #13 at 12:55 p.m. in Station #8. A staff member (#5) uncovered the access site when prompted. During interview on 08/07/24 at 9:35 a.m. an administrative staff member (#4) confirmed patients’ access sites should remain uncovered during treatment.”

“PQ-PCT-STATE REQUIREMENTS & HS DIPLOMA CFR(s): 494.140(e)(1),(2) Patient care dialysis technicians must- (1) Meet all applicable State requirements for education, training, credentialing, competency, standards of practice, certification, and licensure in the State in which he or she is employed as a dialysis technician; and (2) Have a high school diploma or equivalency; This Standard is not met as evidenced by: 19410 Based on review of personnel records, review of the North Dakota Century Code, and review of the North Dakota Administrative Code, the facility failed to ensure 2 of 2 dialysis technicians reviewed (Staff #1 and #2) were registered as an unlicensed assistive person (UAP) as required by the State. Failure to ensure dialysis technicians meet State requirements for registration has the potential to place patients at risk of harm. Findings include: The North Dakota Century Code Nurse Practice Act, Chapter 43-12.1 states, “. . . 43-12.1-02. Definitions. . . . 9. ‘Unlicensed assistive person’ means an assistant to the nurse, who regardless of title is authorized to perform nursing interventions delegated and supervised by a nurse. 43-12.1-03. License or registration required . . . Any person who provides nursing care to a resident of this state must hold a current license or registration issued by the board. It is unlawful for a person to . . . assist in the practice of nursing in this state unless that person is currently licensed or registered under this chapter. . . .” The North Dakota Administrative Code Chapter 54-01-03-01 Definitions states, “. . . 77. ‘Technician’ means an unlicensed assistive person who may perform limited nursing functions within the ordinary, customary, and usual roles in the person’s field. Examples may include . . . dialysis technicians . . . 79. ‘Unlicensed assistive person registry’ means a listing of all persons who are authorized by the board or included on another state registry, which has been recognized by the board to perform nursing interventions delegated and supervised by a licensed nurse. . . .” Review of personnel files occurred on the afternoon of 08/06/24. The file for patient care technicians (Staff #1 and #2) lacked evidence of registration as an unlicensed assistive person (dialysis technician) with the North Dakota Board of Nursing.”