322506 Albuquerque Dialysis (Dci)

“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: 35949 Based on interview, record review, and facility policy review, the facility failed to follow the individualized dialysis prescription as determined by the medical provider for 7 (Patients #1, #2, #3, #4, #5, #6, and #7) of 7 sampled in-center patients. Failure to follow the medical provider’s dialysis prescription had the potential to negatively impact the effectiveness of the prescribed dialysis treatments for the 93 in-center patients who received dialysis treatments at the facility. Findings included: The facility’s policy titled, “Initiation of Dialysis,” revised 09/10/2015, indicated, “Dialysis orders will be entered following the prescription and verified upon initiation of treatment.” 1. Patient #1’s “Hemodialysis Transfer Form” revealed a prescribed dialysate flow rate (DFR) of 700 milliliters per minute (mL/min). Patient #1’s hemodialysis flow sheet, dated 07/13/2024, revealed the DFR was documented as 800 mL/min during the entire treatment. Patient #1’s hemodialysis flow sheet, dated 07/18/2024, revealed the DFR was documented as 800 mL/min during the entire treatment. 2. Patient #2’s “Hemodialysis Transfer Form” revealed a prescribed blood flow rate (BFR) of 350 milliliters per minute (mL/min), a prescribed dialysate flow rate (DFR) of 700 mL/min, and a prescribed hourly infusion of heparin at 1000 units/hour (U/hr). Patient #2’s hemodialysis flow sheet, dated 07/03/2024, revealed no hourly heparin infusion was documented. Patient #2’s hemodialysis flow sheet, dated 07/08/2024, revealed the BFR was documented as 300 mL/min from 2:21 PM until the treatment was terminated at 3:38 PM, the DFR was documented as 800 mL/min during the entire treatment, and no hourly heparin infusion was documented. Patient #2’s hemodialysis flow sheet, dated 07/10/2024, revealed no hourly heparin infusion was documented. Patient #2’s hemodialysis flow sheet, dated 07/12/2024, revealed the DFR was documented as 800 mL/min during the entire treatment and no hourly heparin infusion was documented. Patient #2’s hemodialysis flow sheet, dated 07/15/2024, revealed the DFR was documented as 800 mL/min during the entire treatment and no hourly heparin infusion was documented. Patient #2’s hemodialysis flow sheet, dated 07/16/2024, revealed the BFR was documented as 300 mL/min during the entire treatment and no hourly heparin infusion was documented. Patient #2’s hemodialysis flow sheet, dated 07/19/2024, revealed no hourly heparin infusion was documented. 3. Patient #3’s “Hemodialysis Transfer Form” revealed a prescribed blood flow rate (BFR) of 350 milliliters per minute (mL/min), a prescribed dialysate flow rate (DFR) of 600 mL/min, and a prescribed hourly infusion of heparin at 500 units/hour (U/hr). Patient #3’s hemodialysis flow sheet, dated 07/17/2024, revealed the BFR was documented as 300 mL/min from 12:31 PM until the treatment was terminated at 3:26 PM, the DFR was documented as 800 mL/min during the entire treatment, and no hourly heparin infusion was documented. Patient #3’s hemodialysis flow sheet, dated 07/19/2024, revealed no hourly heparin infusion was documented. 4. Patient #4’s “Hemodialysis Transfer Form” revealed a prescribed blood flow rate (BFR) of 400 milliliters per minute (mL/min) and a prescribed hourly infusion of heparin at 1000 units/hour (U/hr). Patient #4’s hemodialysis flow sheet, dated 07/03/2024, revealed no hourly heparin infusion was documented. Patient #4’s hemodialysis flow sheet, dated 07/05/2024, revealed the BFR was documented as 300 mL/min during the entire treatment and no hourly heparin infusion was documented. Patient #4’s hemodialysis flow sheet, dated 07/08/2024, revealed no hourly heparin infusion was documented. Patient #4’s hemodialysis flow sheet, dated 07/10/2024, revealed no hourly heparin infusion was documented. Patient #4’s hemodialysis flow sheet, dated 07/12/2024, revealed no hourly heparin infusion was documented. Patient #4’s hemodialysis flow sheet, dated 07/15/2024, revealed no hourly heparin infusion was documented. Patient #4’s hemodialysis flow sheet, dated 07/17/2024, revealed no hourly heparin infusion was documented. 5. Patient #5’s “Hemodialysis Transfer Form” revealed a prescribed hourly infusion of heparin at 500 units/hour (U/hr). Patient #5’s hemodialysis flow sheet, dated 07/03/2024, revealed no hourly heparin infusion was documented. Patient #5’s hemodialysis flow sheet, dated 07/05/2024, revealed no hourly heparin infusion was documented. Patient #5’s hemodialysis flow sheet, dated 07/08/2024, revealed no hourly heparin infusion was documented. Patient #5’s hemodialysis flow sheet, dated 07/10/2024, revealed no hourly heparin infusion was documented. Patient #5’s hemodialysis flow sheet, dated 07/12/2024, revealed no hourly heparin infusion was documented. Patient #5’s hemodialysis flow sheet, dated 07/15/2024, revealed no hourly heparin infusion was documented. Patient #5’s hemodialysis flow sheet, dated 07/17/2024, revealed no hourly heparin infusion was documented. Patient #5’s hemodialysis flow sheet, dated 07/19/2024, revealed no hourly heparin infusion was documented. Patient #5’s hemodialysis flow sheet, dated 07/22/2024, revealed no hourly heparin infusion was documented. 6. Patient #6’s “Hemodialysis Transfer Form” revealed a prescribed dialysate flow rate (DFR) of 600 milliliters per minute (mL/min), and a prescribed hourly infusion of heparin at 1000 units/hour (U/hr). Patient #6’s hemodialysis flow sheet, dated 07/03/2024, revealed no hourly heparin infusion was documented. Patient #6’s hemodialysis flow sheet, dated 07/05/2024, revealed no hourly heparin infusion was documented. Patient #6’s hemodialysis flow sheet, dated 07/08/2024, revealed no hourly heparin infusion was documented. Patient #6’s hemodialysis flow sheet, dated 07/10/2024, revealed the DFR was documented as 800 mL/min during the entire treatment and no hourly heparin infusion was documented. Patient #6’s hemodialysis flow sheet, dated 07/12/2024, revealed no hourly heparin infusion was documented. Patient #6’s hemodialysis flow sheet, dated 07/15/2024, revealed no hourly heparin infusion was documented. Patient #6’s hemodialysis flow sheet, dated 07/17/2024, revealed no hourly heparin infusion was documented. 7. Patient #7’s “Hemodialysis Transfer Form” revealed a prescribed blood flow rate (BFR) of 350 milliliters per minute (mL/min), a prescribed dialysate flow rate (DFR) of 2 times the BFR, and a prescribed hourly infusion of heparin at 2500 units/hour (U/hr). Patient #7’s hemodialysis flow sheet, dated 07/04/2024, revealed no hourly heparin infusion was documented. Patient #7’s hemodialysis flow sheet, dated 07/06/2024, revealed no hourly heparin infusion was documented. Patient #7’s hemodialysis flow sheet, dated 07/09/2024, revealed the BFR was documented between 300 mL/min and 330 mL/min and the DFR was documented as 800 mL/min during the entire treatment and no hourly heparin infusion was documented. Patient #7’s hemodialysis flow sheet, dated 07/11/2024, revealed no hourly heparin infusion was documented. Patient #7’s hemodialysis flow sheet, dated 07/13/2024, revealed no hourly heparin infusion was documented. Patient #7’s hemodialysis flow sheet, dated 07/16/2024, revealed no hourly heparin infusion was documented. Patient #7’s hemodialysis flow sheet, dated 07/18/2024, revealed the BFR was documented between 280 mL/min and 300 mL/min during the entire treatment and no hourly heparin infusion was documented. Patient #7’s hemodialysis flow sheet, dated 07/20/2024, revealed no hourly heparin infusion was documented. Patient #7’s hemodialysis flow sheet, dated 07/23/2024, revealed the BFR was documented as 300 mL/min from 12:31 PM until the treatment was terminated at 3:47 PM and no hourly heparin infusion was documented. During an interview on 07/25/2024 at 8:00 AM, the Interim Nurse Manager stated the flowsheets had been reviewed and agreed the flowsheets indicated the physicians’ orders were not followed. During a follow-up interview on 07/25/2024 at 10:00 AM, the Interim Nurse Manager confirmed the staff were trained and expected to follow the physicians’ orders and “to chart reasons why” if the orders were not followed. During an interview on 07/25/2024 at 11:16 AM, the Medical Director confirmed staff were trained and expected to follow physicians’ orders and provide documentation when the orders were not followed. During an interview on 07/25/2024 at 1:10 PM, Registered Nurse #5 confirmed orders should be checked before initiation of a dialysis treatment and reasons documented if orders were not followed as prescribed. During an interview on 07/25/2024 at 1:27 PM, Patient Care Technician #9 confirmed reasons for not following a physicians’ order should be documented and the process for initiation of a dialysis treatment was to check the prescription prior to starting the dialysis treatment.”