322543 Cuba Dialysis (Dci)

“IC-ASEPTIC TECHNIQUES FOR IV MEDS CFR(s): 494.30(b)(2) [The facility must-] (2) Ensure that clinical staff demonstrate compliance with current aseptic techniques when dispensing and administering intravenous medications from vials and ampules; and This Standard is not met as evidenced by: 28297 Based on observation, interview, and policy review, the facility failed to ensure expired medications were disposed of during one of three survey days. Failure to remove expired medical supplies had the potential to affect 24 in-center patients receiving dialysis treatments at the facility. In addition, the facility failed to ensure one of one registered nurses completed medication preparation as required for one of two observations. The failure to complete medication preparation as required had the potential for cross contamination of medication and this could affect 24 in-center patients. Findings include: During an observation of the medication refrigerator on 07/22/24 at 12:20 PM, 16 pre-filled Influenza vaccine syringes were found to be expired 06/24. During an interview on 07/22/24 at 12:20 PM, Registered Nurse (RN) 1 confirmed the medications were expired. RN1 stated they did not complete monthly audits for expired medications and only checked the medication for expiration dates prior to use. During an interview on 07/24/24 at 12:40 PM, the Facility Administrator stated the medications should be checked monthly when stock comes in to ensure medications were not expired. During an observation on 07/22/24 at 3:40 PM, revealed RN 1 preparing medications for (Patient) P6. RN1 used one syringe to withdrawal medication from a multidose vial then opened a new multidose vial of the same medication and used the same syringe to enter the new vial. During an interview on 07/24/24 at 12:30 PM, RN1 confirmed he/she used the same syringe for two multidose vials which was against facility policy. During an interview on 07/24/24 at 12:40 PM, the Facility Administrator confirmed two different syringes should not have been used for multidose vials per facility policy. Review of the facility’s policy titles “Medications,” revised 11/05/2019, revealed there was nothing indicated in the policy on checking for expired medications. The policy did indicate ... “If another vial of the same medication and same concentration is necessary, the medication may be drawn into the same syringe if both vials are single dose and are discarded after the single entry into each. However, if either vial is a multiuse, a different syringe and needle must be used for entry in each vial ...””

“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: 28297 Based on observation, interview, and policy review, the facility failed to ensure one of one Registered Nurses (RN)1 completed Central Venous Catheter (CVC-a flexible tube inserted into a vein to access the bloodstream for hemodialysis) care prior to treatment initiation for one of two observations. The failure to complete the dressing change first had the potential for missed opportunities to capture CVC issues at the insertion site and this could affect five patients with CVC’s in the facility. Findings include: During an observation on 07/22/24 at 12:26 PM, RN1 was with (Patient) P5 initiating treatment via a CVC. The patient’s CVC insertion site was covered with gauze and could not be visualized. RN1 then completed the dressing change after the treatment had started. During an interview on 07/22/24 at 12:30 PM, RN1 acknowledged the CVC dressing change should have been changed prior to treatment initiation to ensure visualization of the CVC insertion site to identify potential complications. During an interview on 07/24/24 at 12:40 PM, the Facility Administrator confirmed the patient’s CVC dressing should be changed prior to initiation of hemodialysis treatment to ensure there were no complications with the catheter. Review of the facility’s policy Central Venous Catheter (CVC) Exit Site Disinfection and Dressing Change,” revised December 20, 2018, indicated the following: “ ...Catheter care and dressing changes should be done prior to treatment initiation ...””

“POC-COMPLETED/SIGNED BY IDT & PT CFR(s): 494.90(b)(1) The patient’s plan of care must- (i) Be completed by the interdisciplinary team, including the patient if the patient desires; and (ii) Be signed by the team members, including the patient or the patient’s designee; or, if the patient chooses not to sign the plan of care, this choice must be documented on the plan of care, along with the reason the signature was not provided. This Standard is not met as evidenced by: 28297 Based on interview, record review, and review of facility policy, the facility failed to ensure five of five (Patients (P) 1, P2, P3, P4, and P5) were given the opportunity to attend and participate in their Plan of Care (POC). The failure to give patients opportunities to be involved in their POC had the potential for missed opportunities for improved care and for patients to validate that they had been informed about the information in the POC. Findings include: 1. Review of the “Face Sheet” provided by the facility for P1 revealed the facility admitted the patient on 11/02/22 with a diagnosis of end stage renal disease (ESRD). Review of P1’s annual “POC” provided by the facility dated 06/28/24 revealed the patient did not sign off on the “POC” to indicate the patient participated in the “POC.” 2. Review of the “Face Sheet” provided by the facility for P2 revealed the facility admitted the patient on 02/26/18 with a diagnosis of ESRD. Review of P2’s annual “POC” provided by the facility dated 07/13/22 and 07/28/23 revealed the patient did not sign off on the “POC” to indicate the patient participated in the “POC.” 3. Review of the “Face Sheet” provided by the facility for P3 revealed the facility admitted the patient on 06/17/20 with a diagnosis of ESRD. Review of P3’s annual “POC” provided by the facility dated 11/10/23 revealed the patient did not sign off on the “POC” to indicate the patient participated in the “POC.” 4. Review of the “Face Sheet” provided by the facility for P4 revealed the facility admitted the patient on 03/01/24 with a diagnosis of ESRD. Review of P4’s initial “POC” provided by the facility dated 05/29/24 revealed the patient did not sign off on the “POC” to indicate the patient participated in the “POC.” 5. Review of the “Face Sheet” provided by the facility for P5 revealed the facility admitted the patient on 03/08/24 with a diagnosis of ESRD. Review of P5’s initial “POC” provided by the facility dated 03/22/24 revealed the patient did not sign off on the “POC” to indicate the patient participated in the “POC.” During an interview on 07/24/24 at 10:00 AM, the Social Worker stated the Nurse was responsible for informing the patient of the care plan and getting the signature after the POC meeting. During an interview on 07/24/24 at 12:30 PM, Registered Nurse (RN) 1 stated the Nurse Manager used to get the POC’s signed by the patient but they were no longer at the facility. RN1 stated he/she did not realize he/she needed to get the patients to sign the POC’s. During an interview on 07/24/24 at 12:40 PM, the Facility Administrator acknowledged the POC’s were not signed and that there was a consistent issue with the POC’s not getting signed by the patient. The Facility Administrator stated it was important for patient to sign the POC’s to ensure they acknowledge the information. Review of the facility’s policy “Comprehensive Care Plan (Universal)” revised June 14, 2011, indicated the following: “ ...Signatures: This section is designed for all of the health care team and the patient/designee to document their signature indicating that they have reviewed the plan of care ...””