Fmc Madras Dialysis

“PE-SAFE/FUNCTIONAL/COMFORTABLE ENVIRONMENT CFR(s): 494.60 The dialysis facility must be designed, constructed, equipped, and maintained to provide dialysis patients, staff, and the public a safe, functional, and comfortable treatment environment. This Standard is not met as evidenced by: 31224 Based on observation and review of documentation, it was determined the facility failed to maintain a safe and functional treatment environment. Findings: Observation of the medication refrigerator on 04/15/2024 at 0935 revealed the following medications remained in the refrigerator and available for patient use: * One MDV of tuberculin (an extract used to test for tuberculosis exposure) labeled as opened on 01/22/2024. * One MDV of Epogen (a medication used to treat anemia) labeled as opened on 12/08/2023. Review of facility policy titled, “Medication Preparation and Administration,” dated 02/06/2023, stipulated, “Any open multi dose vials must be discarded 28 days after opening or per manufacturer’s expiration date.” During interview on 04/15/2024 at 0935, the CM confirmed the above findings.”

“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: 31224 Based on interview, review of patient medical records and review of documentation, it was determined that the facility failed to ensure that patients received appropriate and timely hemodialysis monitoring or that the dialysis prescription was followed for 2 of 2 patients (Patient #s 1 and 2). Findings: 1. Review of Patient #2’s dialysis orders and treatment sheets dated 03/15/2024 through 04/15/2024 (14 hemodialysis treatments) reflected the physician order for BFR was 400 mL/min. The treatment flowsheets reflected the BFR was set or changed to a rate different than what was ordered by the PCT or RN. PCT documentation and RN evaluation did not note why the physician orders were not followed. For example: * On 03/25/2024, the BFR was decreased to 300 mL/min at 1131 by the PCT with no documentation to note why the rate was changed. * On 03/27/2024, the PCT entered the BFR at 350 mL/min at 1005. At 1205, the PCT decreased the BFR to 300 mL/min. There was no documentation to note why the physician order was not followed or why the rate was chaged. Similar findings were noted on 03/18/2024, 03/22/2024, 03/29/2024, 04/01/2024, 04/08/2024, and 04/10/2024. * The treatment flowsheets reflected vital signs and access checks were missed: - On 03/25/2024, the PCT documented a VS and access check at 1159. The RN documented an access check, but no vital signs check, 66 minutes later at 1305. The next time both a VS and access check was documented by the PCT was 101 minutes later at 1340. - On 04/12/2024, the PCT documented a VS and access check at 1141. The next VS and access check was documented 53 minutes later at 1234. - On 04/15/2024, the RN documented VS at 1100. The next VS was documented 66 minutes later at 1206. 2. Similar findings were identified for Patient #1. 3. Review of facility policy titled,”Patient Assessment and Monitoring,” dated 05/01/2023, stipulated: * “Obtain blood pressure and pulse rate every 30 minutes or more as needed but not to exceed 45 minutes or per state regulations.” * “Document machine parameters and safety checks every 30 [min] or more often as needed but not to exceed 45 minutes or per state regulations.” * “Check prescribed blood flow is being achieved or reason is documented in medical record if unable to meet prescribed blood flow.” * “Check dialysate flow rate setting is correct, and the prescribed flow is being delivered.” During an interview on 04/16/2024 at 1100, the CM confirmed the above findings.”

“PA-IMMUNIZATION/MEDICATION HISTORY CFR(s): 494.80(a)(3) The patient’s comprehensive assessment must include, but is not limited to, the following: Immunization history, and medication history. This Standard is not met as evidenced by: 47148 Based on interview and review of documentation, it was determined that the facility failed to offer pneumococcal vaccination to patients based on assessment of status as required by facility policy and CDC guidelines for 3 of 34 patients (Patient #s 5-7). Findings: Review of the “Pneumonia Vaccination Report,” printed on 04/14/2024 revealed the vaccination status for 34 patients on the facility census. The “Suggested Action(s)” column for 2 of the 3 patients (#5 and #7) advised administration of the appropriate pneumococcal vaccine product specific to each patient based upon age and current vaccination status per facility policy. Documentation failed to reflect that the vaccination had been offered to those patients. Examples include but are not limited to: * Patient #5 had documentation of receiving PPSV23 on 10/03/2016. According to facility policy, as well as CDC guidelines, this patient should have received a pneumococcal vaccine in 2021. * Patient #7 had documentation of receiving PPSV23 on 10/18/2019. According to facility policy, as well as CDC guidelines, this patient should have received a pneumococcal vaccine in 2020. No other documentation as to subsequent pneumococcal vaccine given, offered or refused was noted. Further review of the “Pneumonia Vaccination Report” revealed patient #6’s “Current Pneumococcal Vacination Status” reflected as “Vaccinated Elsewhere.” Documentation failed to reflect which vaccine was administered in the past therefore their vaccination status is unknown. Review of the facility policy titled, “Pneumococcal Vaccine for Adults,” dated “02/05/2024 Version: 6” stipulated the following: * “Patients should receive vaccines based on the administration frequencies outlined below.” The policy provided guidelines for offering pneumococcal vaccines to patients based on age and vaccination history as recommended by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices in September 2023. * “Adults aged 19 and older diagnosed with chronic renal failure ... whose previous vaccination history is unkown, should receive: One dose of Prevnar 20.” During an interview with the FA on 04/17/2024 at 1000, the above findings were confirmed.”