Fmc - Ohio Renal CARE Group Euclid

“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: 29732 Based on record review, interview and policy review, the facility failed to ensure staff documented information collected during treatment. This affected two (Patients #2 and #3) of three patients reviewed. Findings include: 1a. Review of the treatment sheet for Patient #3, dated 09/04/24, revealed the pre-dialysis blood pressure (BP) was 167/83 with a pulse of 72. Treatment was started at 6:03 AM with a BP of 146/71. At 6:55 AM Patient #3’s BP was 80/37. PCT Staff O documented “low BP” but did not document if the RN was notified and did not document that the ultrafiltration (fluid removal) was turned off. At 7:40 AM, Patient #3’s BP was 124/60 and PCT Staff O turned the ultrafiltration back on without documentation of this action. During an interview on 09/19/24 at 10:38 AM, the Facility Administrator confirmed the PCT Staff O did not notify the RN when the BP dropped below 100 systolic and did not document when the ultrafiltration was turned off or back on. 1b. Review of the treatment sheet for Patient #3 dated 09/04/24 revealed “Special Attentions” to utilize Midodrine (medication used for low BP) on hemodialysis days. The order read to take Midodrine 5 milligrams (mg) before treatment. Repeat one time for systolic blood pressure less than 100 during treatment. There was no documentation the staff offered Midodrine to Patient #3 at 6:55 AM when the BP was 80/37 or at 8:30 AM when the BP was 70/40. During an interview on 09/19/24 at 12:02 PM, the Medical Director stated the staff should have offered it to Patient #3 when the systolic blood pressure dropped below 100 during treatment. During an interview on 09/19/24 at 1:18 PM, the Facility Administrator stated typically all patients carry the Midodrine medication with themselves, but confirmed the staff should have at least offered it to Patient #3 when the systolic blood pressure dropped below 100. The Facility Administrator stated RN Staff I was still in training with RN Staff K overseeing. It was confirmed there was no documentation from the Charge Nurse Staff K of overseeing the trainee RN Staff I or of reassessing Patient #3 each time the patient’s systolic blood pressure dropped below 100. 2. Review of the treatment sheet for Patient #2, dated 09/04/24, revealed the treatment started 7:26 AM with a BP of 138/86. At 10:04 PM the BP was 97/68. PCT Staff P documented Patient #2 was resting comfortably and denied complaints; however, the RN was notified, ultrafiltration was turned off, 100 milliliters (ml) of normal saline was given for low BP and oxygen at two liters per minute was applied to Patient #2. During an interview on 09/19/24 at 3:08 PM, the Facility Administrator stated after talking to PCT Staff P they stated Patient #2 wanted to go to the bathroom around 10:00 AM but began to violently vomit and didn’t make it to the bathroom. The Facility Administrator confirmed there was no documentation Patient #2 started vomiting or was assessed by a RN. Review of the facility policy titled “Nursing Supervision and Delegation”, effective 11/06/23, revealed the staff member who collects information pre, post and during treatment will document their findings. Any observed changes or abnormal findings in the patient ‘s condition or changes reported by the patient, must be reported to the registered nurse who will assess the patient. When to Refer a Patient to the RN: If B/P less than or equal to 100 millimeters of mercury (mm/hg) systolic during treatment.”