322552-Fmc Sandhill

“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: 47302 Based on record review and interview the facility failed to sustain the prescribed dose of dialysis for 2(P [patient]3, and P4) out of 5 (P1-P5) patients reviewed for adherence to orders. This deficient practice may lead to patient’s not achieving adequacy from their dialysis treatments. The findings are: A. Record review of the facility’s policy titled, “Physician Order Documentation” dated 07/03/2023 on page 1, under “Background” stated, “All medications, laboratory tests and treatments a patient receives require an electronic order signed by the physician, nurse practitioner, or physician assistant (in states where allowed). It is the nurses’ responsibility to ensure that all treatments, medications, labs or any care provided to the patient have an accurately documented physician order.” Under “General Policy” stated, “Nurse practice acts require nurses to carry out treatment care, medication administration, lab tests, procedures, and other treatments, based on physician orders. - These orders can be entered electronically, given by telephone, or by facsimile if allowed by state law. - Providing service without physician orders is in violation of nurse practice acts. Other disciplines such as dietitian are required to follow their scope of practice according to state law. An order is needed whenever a new medication, lab test or other procedure is ordered, or when the dose of a medication is changed. . .” B. Record review of P3’s hemodialysis orders and treatment sheets revealed: 1. Hemodialysis orders revealed that the DFR (dialysate flow rate; flow of the fluid in the dialysis process) was ordered to run at a flow rate of 500 mL/min (milliliters per minute). 2. Treatment sheet for 08/26/2024 revealed that the DFR was running at 700. The record did not contain any evidence that the order was changed nor was it documented why the prescribed dialysate rate was exceeded. C. Record review of P4’s hemodialysis orders and treatment sheets revealed: 1. Hemodialysis orders revealed that the DFR was ordered to run at a flow rate of 600 mL/min. 2. Treatment sheet for 08/19/2024 revealed that the DFR was running at 800. The record did not contain any evidence that the order was changed nor was it documented why the prescribed dialysate rate was exceeded. 3. Treatment sheet for 08/23/2024 revealed that the DFR was running at 800. No evidence was found that the order was changed nor was it documented why the prescribed dialysate rate was exceeded. D. During an interview on 08/29/2024 ay 11:25 AM with S(Staff)1, clinical, when asked why P3’s and P4’s DFR was changed S1 explained that it looks like the machine setting was not changed from “Autoflow” (the machine sets the DFR based on the blood flow rate). S1 confirmed the orders for these patients were not followed.”

“MD RESP-ENSURE ALL ADHERE TO P&P CFR(s): 494.150(c)(2)(i) The medical director must- (2) Ensure that- (i) All policies and procedures relative to patient admissions, patient care, infection control, and safety are adhered to by all individuals who treat patients in the facility, including attending physicians and nonphysician providers; This Standard is not met as evidenced by: 49835 Based on record review, interviews and observation the facility failed to ensure staff followed policy and procedure to label multi-use medication vials. The failure to follow this policy and procedure could cause harm to all patients receiving care at the facility by receiving expired or contaminated medications. The findings are: A. Record review of the facility’s policy and procedure titled, “Medication Preparation and Administration” dated 02/06/2023 under section “Labeling Vials” stated “the nurse or PCT (if allowed by state regulations), must place date the vial was opened on the medication label along with their initials. Note: To ensure all open vials are properly marked, the nurse must never walk away from an opened multi-dose vial without writing the date and time the vial was opened.” B. During an observation on 08/28/2024 at 7:33 am, there was 2 multi-dose vials of Heparin (medication used to prevent clotting of central lines) opened with no date of opening and no initials of staff member that opened them. There were 8 other multi-dose bottles of medications opened without a date of opening or an initial of staff that opened them. C. During interview with S (Staff)7, clinical, on 8/28/2024 at 7:36 am, it was confirmed that the multi-dose vial of Heparin should be dated with date opened and initialed by the staff member opening them. D. During interview on 8/28/2024 at 12:45 pm with S1, clinical, it was confirmed that all multi-dose medication vial and bottles should have a date of opening and initials of staff opening the medications.”