322509 Rio Rancho Dialysis (Fmc)

“CFC-PATIENT ASSESSMENT CFR(s): 494.80 This Condition is not met as evidenced by: 50656 Based on observation and staff interview the facility failed to meet the Condition for Coverage to ensure the safety of hemodialysis (HD) patients by not following prescribed hemodialysis treatments as ordered by a medical provider. This deficient practice could lead to complications such as electrolyte imbalances (a condition where there is either too much or not enough of certain mineral in the body) and blood pressure changes that could lead to irregular heartbeat, fluid overload (a condition where there is too much fluid in the body which can raise blood pressure, cause swelling and harm the body), muscle cramps, and in some cases cardiac arrest or death for all patients receiving HD treatment at the facility. The findings are: A. Refer to Tag V503”

“Dialysis Emergency Equipment CFR(s): §494.62(b)(9) Condition for Coverage: [(b) Policies and procedures. The dialysis facility must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years. At a minimum, the policies and procedures must address the following:] (9) A process by which the staff can confirm that emergency equipment, including, but not limited to, oxygen, airways, suction, defibrillator or automated external defibrillator, artificial resuscitator, and emergency drugs, are on the premises at all times and immediately available. This Standard is not met as evidenced by: 49835 Based on record review, observation, and interview the facility failed to provide emergency medication in the crash cart that are needed for medical emergencies such as a cardiac arrest for the patient receiving dialysis treatment in the facility. The deficient practice could lead to facility not being able to rapidly respond to health emergencies to all patients receiving treatment at the facility. The findings are: A. Record review of the facility’s policy titled “Emergency Medications, Equipment and Supplies” dated 05/01/2023 under section Definitions: stated Emergency Cart: “An emergency cart, sometimes called “crash cart” contains emergency equipment and medications for medical emergencies such as cardiac arrest.” B. During an interview on 11/20/2024 at 11:50 am with S [staff] 19 (clinical), S19 stated the checklist is now completed in the computer and the medications are no longer kept in the crash cart and kept at the nurses station in the cupboard. C. Record review of the facility’s document titled “Emergency Code Cart and Medication Checklist (Monthly) v5 - 80818 for the months of September and October 2024, it is documented on the checklist all medications are stored in the crash cart. D. During an interview on 11/20/2024 at 11:50 am with S [staff] 19 (clinical), S19 stated the checklist is now completed in the computer and the medications are no longer kept in the crash cart and kept at the nurses station in the cupboard. E. During an observation on November 20, 2024 at 11:52 am, S19 opened up a cupboard by the nurses station and removed the emergency medication box and pointed out that the medications F. During an observation of the emergency crash cart on November 20, 2024 at 12:00 pm there were no medications in the emergency crash cart. G. During an interview on November 20, 2024 at 12:05 pm with S19 (clinical) when asked if the policy “Emergency Medications, Equipment and Supplies” dated 05/01/2023 stated the emergency medications should be in the crash cart. S9 confirmed that is what the policy states. H. During an interview with S6 (non-clinical) on 11/20/2024 at 12:10 pm when asked if the emergency medications should be in the crash cart after reviewing the policy. S6 confirmed that the emergency medication should be kept in the crash cart.”

“IC-DISINFECT SURFACES/EQUIP/WRITTEN PROTOCOL CFR(s): 494.30(a)(4)(ii) [The facility must demonstrate that it follows standard infection control precautions by implementing- (4) And maintaining procedures, in accordance with applicable State and local laws and accepted public health procedures, for the-] (ii) Cleaning and disinfection of contaminated surfaces, medical devices, and equipment. This Standard is not met as evidenced by: 50656 Based on observation, record review, and staff interview the facility failed to ensure personalized reusable blood pressure cuffs were sterilized after dialysis treatment sessions for 2 (Patient (patient)1 and P5) out of 24 (P1-P24) patients observed after treatments were completed. This deficient practice has the potential to expose all patients receiving care to be exposed to potentially infectious pathogens (organisms that can lead to illness) exposure while receiving hemodialysis treatments. The findings are: A. During an observation on 11/19/24 at 10:42 am, clinical staff member S(staff)3 removed a blood pressure (BP) cuff from P1’s arm following the completion of dialysis treatment without sanitizing the BP cuff after the cuff was used. B. During an observation on 11/19/24 at 11:14 am, clinical staff member S1 removed a personalized reusable blood pressure cuff from P5’s arm after dialysis treatment had completed without sanitizing the BP cuff after the cuff was used. C. During an interview with clinical staff member S1, the staff member was asked when the reusable BP cuff were sanitized. S1 replied “Maybe once a week.” D. During an interview with clinical staff member S19, the staff member was asked how often the reusable BP cuffs are supposed to be sanitized. S19 replied “ Yes, they are sanitized every day, right after they have completed their dialysis treatment per policy.” E. Record review of the facility’s policy labeled “Cleaning and Disinfecting the Blood Pressure Cuff”, publication date of 09/05/2023, page 1 of 2 listed under Noncritical Items (items that come in contact with skin but not mucous membranes (a membrane that lines certain part of the body): Directions for Disinfection of Blood Pressure Cuff after Patient Use [sic]. The document stated the following: “Follow the steps below to disinfect the blood pressure cuff Step 1. Wipe the cuff with a cloth wetted with 1:100 bleach solution being sure to wipe both sides of the cuff. Step 2. Allow to dry before placing on the patient’s arm””

“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: 50656 Based on record review and staff interview, the facility failed to ensure the safety of hemodialysis (HD) patients by not following the prescribed hemodialysis treatments as ordered by a medical provider for 6 (P (patient)5, P6, P18, P25, P26 and P27) out of 6 (P5, P6, P18, P25, P26 and P27) patients audited for HD prescription accuracy. This deficient practice could lead to complications such as electrolyte imbalances (a condition where there is either too much or not enough of certain mineral in the body) and blood pressure changes that could lead to irregular heartbeat, fluid overload (a condition where there is too much fluid in the body which can raise blood pressure , cause swelling and harm the body), muscle cramps, and in some cases cardiac arrest or death for all patients receiving HD treatment at the facility. The findings are: P18 A. Record review of P18’s electronic medical record (EMR) revealed that P18 was not receiving the correct HD prescription as ordered by the patient’s medical provider with the following discrepancies: Blood flow rate (BFR), (the speed at which blood is pumped from the body through the dialysis machine) setting was observed to be a setting of 425 millimeters per minute (mL/min), while record review was for a BFR at setting of 400 mL/min. The dialysate (fluid that has water, salt and electrolytes) fluid temperature setting was at 35.5 degrees Celsius (C), while record review of the physician order was for the temperature setting to be at 37.0 C. B. Review of P18’s EMR revealed the record did not contain any documentation by clinical staff that recorded the date, time or reason for the changes of P18’s prescribed HD treatment to the treatment the patient received. P6 C. Record review P6’s EMR, revealed that the patient was not receiving the correct HD prescription as ordered by the patient’s medical provider with the following discrepancies: BFR setting observed to be 350 mL/min, while review of the EMR showed the physician order for BFR for a setting of 300 mL/min. Review of the EMR showed the dialysate fluid temperature setting at 36.5 degrees C, review of the EMR showed the physician order for a temperature setting of 37.0 C. D. Record review of P6’s EMR revealed the record did not contain any documentation by clinical staff that recorded the date, time or reason for the changes of P6’s prescribed HD treatment to the treatment the patient received. P25 E. Record review of P25’s EMR revealed that the patient was not receiving the correct HD prescription as ordered by the patient’s medical provider with the following discrepancy: The dialysate fluid temperature setting observed to be 36.5 degrees C, review of the EMR showed the physician order for a temperature setting of 37.0 C. F. During an interview on 11/21/24 at 10:19 am, clinical staff member, S (staff) 6 stated that machine used for HD treatment for P25 was not at the correct dialysate setting, but P25 was receiving the correct “bath” (dialysis fluid mixture). When S6 was asked why the setting was not correct but the patient was receiving the correct “bath.” S6 responded “The machine needs to be calibrated (to adjust an instrument so that it function accurately).” When S6 was asked if the HD machine should be used if it requires calibration. S6 responded “No, it should not.” G. Record review of P25’s EMR revealed the record did not contain any documentation by clinical staff that recorded the date, time or reason for the changes of P25’s prescribed HD treatment to the treatment the patient received or the need for the machine to be recalibrated. P5 H. Record review of P5’s EMR revealed that the patient was not receiving the correct HD prescription as ordered by the patient’s medical provider with the following discrepancies: The dialysate fluid temperature setting observed to be 36.5 degrees C, the physician order for a temperature setting of 37.0 C. I. Review of P5’s EMR revealed the record did not contain any documentation by clinical staff that recorded the date, time or reason for the changes of P5’s prescribed HD treatment to the treatment the patient received. P26 J. Record review of P26’s EMR revealed that the patient was not receiving the correct HD prescription as ordered by the patient’s medical provider with the following discrepancies: BFR setting observed to be 300 mL/min, while the physician order for BFR was for a setting of 400 mL/min. K. Record review of P26’s EMR revealed the record did not contain any documentation by clinical staff recording the date, time or reason for the changes of P26’s prescribed HD treatment to the treatment the patient received. P27 L. Record review of P27’s EMR revealed that the patient was not receiving the correct HD prescription as ordered by the patient’s medical provider with the following discrepancies: The BFR setting observed to be 350 mL/min, while the physician order for BFR was for a setting of 400 mL/min and the dialysate fluid temperature setting was at 35.5 degrees C, while review of the EMR showed an order for a temperature setting of 36.0 C. A fluid removal profile setting (a setting ordered by a medical provider to determine the rate at which fluid is removed from the body during a dialysis session) was set at zero while record review showed the physician order was for the setting to be at a level of 4. M. Record review of P27’s EMR revealed the record did not contain any documentation by clinical staff recording the date, time or reason for the changes of P27’s prescribed HD treatment to the treatment the patient received.”