Usrc Crownpoint Dialysis

“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: 49835 Based on record review, observation, and interview, the facility failed to ensure appropriate hand hygiene was performed while disconnecting 1 (P1 (patient) out of 2 (P1 and P2) patients from the dialysis machine with a central venous catheter. This deficient practice could lead to sepsis (infection in the blood) in all patients receiving dialysis with a central venous catheter. The findings are: A. Review of the facility’s policy titled “Hand Hygiene” revised 08/2020 under “Hand Hygiene” will be performed. Number 3 “Prior to contact with vascular access site,” number 6 “before clean/aseptic procedure ( preventing infection)” number 8 “After touching patient surrounding (e.g., dialysis machine, any item in the dialysis area or chairside computers).” Policy indicated to perform hand hygiene prior to contact with vascular access site, before clean/aseptic procedure, and after touching patient surrounding (e.g., dialysis machine, any item in the dialysis area or chairside computers)”. B. During observation of P1 10/01/2024 at 10:15 am S (staff) S3 (clinical) was disconnecting P1 from the dialysis machine. During this procedure S3 touched the dialysis machine, the bedside computer table, and the dialysis chair armrest, then proceeded to disconnect P1 from the dialysis machine. S3 continued to provide care for the central venous catheter without removing gloves and performing hand hygiene. C. During an interview with S3 on 10/01/2024 at 10:30 am, when asked if S3 should have removed the gloves and washed her hands after touching the dialysis machine, the bedside computer table and the armrest of the P1’s dialysis chair, S3 stated “No, I washed my hands and put on clean gloves before I started discontinuing the dialysis of P1 from the dialysis, I don’t have to wash again” D. During an interview with S1 (clinical) and S2 (clinical) on 10/01/2024 at 11:15 am, when asked if the nurse should have completed hand washing after touching the dialysis machine, computer table and the armrest of the dialysis chair. S1 confirmed that the nurse should have performed hand hygiene and changed gloves prior to performing care to the central line catheter.”

“IC-STAFF EDUCATION-CATHETERS/CATHETER CARE CFR(s): 494.30(a)(2) Recommendations for Placement of Intravascular Catheters in Adults and Children I. Health care worker education and training A. Educate health-care workers regarding the ... appropriate infection control measures to prevent intravascular catheter-related infections. B. Assess knowledge of and adherence to guidelines periodically for all persons who manage intravascular catheters. II. Surveillance A. Monitor the catheter sites visually of individual patients. If patients have tenderness at the insertion site, fever without obvious source, or other manifestations suggesting local or BSI [blood stream infection], the dressing should be removed to allow thorough examination of the site. Central Venous Catheters, Including PICCs, Hemodialysis, and Pulmonary Artery Catheters in Adult and Pediatric Patients. VI. Catheter and catheter-site care B. Antibiotic lock solutions: Do not routinely use antibiotic lock solutions to prevent CRBSI [catheter related blood stream infections]. This Standard is not met as evidenced by: 49835 Based on record review, observation and interviews the facility failed to to ensure safe practice was used while disconnecting 1(P (patient) 1) out of 2 (P1 and P2) patients from the dialysis machine. S (staff) 3) failed to place the sterile cap (cap used to cover the opening of the Central Venous Catheter (a tube placed in vein for dialysis). This deficient practice could lead to sepsis (infection in the blood) for all patients with a central venous catheter used for dialysis. The findings are: A. Review of the facility’s policy titled “Accessing and De-Accessing the Dialysis Catheter” revised 06/2024 stated under Procedure: number 6a ... never leave an uncapped catheter unattended. B. During the observation of P1 being disconnected from the dialysis machine with a central venous catheter on 10/01/2024 at 10:15 am S (staff) S3 (clinical), S3 walked away from P1 with the blue port (opening to the central line) P1 did not have a sterile cap from 10:25 am to 10:30 am. S3 returned and wiped the blue port with alcohol wipe and place a sterile cap on the end of the line. C. During an interview with S3 (clinical) on 10/01/2024 at 10:31 am when asked if the central venous catheter should be left without a sterile cap S3 stated “No I just needed to go get one.” D. During an interview with S1 (clinical), she confirmed that the central venous catheter should never be without a cap and the nurse should not have left it that way for any amount of time.”

“POC-MANAGE VOLUME STATUS CFR(s): 494.90(a)(1) The plan of care must address, but not be limited to, the following: (1) Dose of dialysis. The interdisciplinary team must provide the necessary care and services to manage the patient’s volume status; This Standard is not met as evidenced by: 49844 Based on record review and interview the facility failed to ensure the interdisciplinary team provided necessary care to manage the patients volume status by failing to adjust the estimated desired weight (EDW) (weight of patient after receiving dialysis) for 1 patient (P[patient]4) out of 5 (P1-P5) patients being reviewed. This deficient practice could possibly result in fluid overload in the dialysis patients. The findings are: A. Record review of P4’s medical record revealed the following: 1. P4 had an order for EDW of 67.5 kg (Kilograms). 2. On 09/19/24 the patient’s pre-dialysis weight (weight after dialysis treatment) was lower than the EDW at 65.7 kg. The patient’s post-dialysis weight is 65.9 kg. 3. For the treatment on 09/26/24 the patients ordered EDW remained at 67.5 kg and the patient’s pre-dialysis weight was lower than the EDW at 65.5 kg and the patient’s post-dialysis weight was 65.3. The EDW was not updated for P4. B. During an interview on 10/02/24 at 1:30 PM with S (staff) 2, non-clinical, when asked if P1 met the EDW. S2 stated “no” and also confirmed that the EDW should have been adjusted with the patients weight.”

“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: 49844 Based on record review and interview the facility failed to administer and sustain the prescribed dose of dialysis (order from the provider for the rate at which dialysis should be performed) for 1(P[patient]4) out of 5 (P1-P5) patients being reviewed for dialysis adequacy. This deficient practice could possibly lead to an inadequate dialysis treatment. The findings are: A. Record review of P4’s medical record revealed under the section orders that the providers ordered blood flow rate as 400 (rate ordered by the provider that blood will be pumped through a dialyzer and back into the patients body) for the dialysis session on 09/19/24. Under the section “Hemodialysis Flowsheet” revealed that on 09/19/24, P4’s blood flow rate was at 350. The record did not contain any indication documented as to why the rate was changed. B. During an interview on 10/02/24 at 1:30 PM with S (staff) 2, Non-clinical, when asked if the dialysis was administered as ordered on 09/19/24. S2 confirmed that dialysis was not administered as ordered and it was uncertain as to why because it is not documented in the medical record.”