Fkc Uniontown

“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: 42178 Based on review of facility policy, medical records (MR), and staff (EMP) interview the facility failed to perform patient vitals and/or safety check per policy for nine (9) of nine (9) In-Center Hemodialysis MR reviewed. (MR 1-9) The facility also failed to follow policy related to monitoring patient blood pressure for four (4) of nine (9) In-Center Hemodialysis MR reviewed. (MR 2-4 & 7) Findings Included: Review of facility policy on 11/16/23 at approximately 8:45am revealed: “Patient Assessment and Monitoring...During Treatment-Obtain blood pressure and pulse rate every 30 minutes or more as needed but do not exceed 45 minutes or per state regulations. Document machine parameters and safety checks every 30 [minutes] or more often as needed but do not exceed 45 minutes or per state regulations...Blood Pressure...Report to the nurse: Systolic blood pressures greater than 180mm/Hg, Diastolic blood pressures greater than 100mm/Hg...” Review of MR on 11/16/3223 between approximately 9:00am and 4:00pm revealed: MR1, Admission date 8/3/23, dates reviewed 11/123-11/13/23. 11/1/23- Treatment record revealed 60 minutes between documented vitals checks at 8:30am and 9:30am. Treatment records also revealed 60 minutes between documented safety checks at 8:31am and 9:31am 11/6/23- Treatment record revealed 59 minutes between documented vitals checks at 6:34am and 7:33am. Treatment records also revealed 56 minutes between documented safety checks at 6:34am and 7:30am. 11/8/23- Treatment record revealed 63 minutes between documented vitals checks at 8:32am and 9:35am. Treatment records also revealed 58 minutes between documented safety checks at 8:32am and 9:30am. 11/10/23- Treatment record revealed 55 minutes between documented vitals checks at 9:35am and 10:30am. MR2, Admission date 6/14/23, dates reviewed 11/1/23-11/13/23. 11/1/23- Systolic blood Pressure (bp) reading of 89 at 1:01pm recorded by patient care technician (PCT). No evidence of notification to Registered Nurse (RN) of findings out of facility parameters. Treatment record revealed 60 minutes between documented vitals checks at 1:34pm and 2:34pm. Treatment records also revealed 64 minutes between documented safety checks at 1:30pm and 2:34pm. 11/3/23- Systolic bp reading of 93 at 1:03pm recorded by PCT. No evidence of notification to RN of findings out of facility parameters. 11/6/23- Systolic bp reading of 94 at 2:02pm and 90 at 3:07pm recorded by PCT. No evidence of notification to RN of findings out of facility parameters. 11/8/23- Systolic bp reading of 78 at 1:34pm, 95 at 2:07pm, and 97 at 2:33pm recorded by PCT. No evidence of notification to RN of findings out of facility parameters. 11/10/23- Systolic bp reading of 98 at 12:34pm and 94 at 2:54pm, recorded by PCT. No evidence of notification to RN of findings out of facility parameters. MR3, Admission date 8/18/23, dates reviewed 11/1/23-11/13/23. 11/1/23- Pulse reading of 116 beats per minute at 8:30am recorded by PCT. No evidence of notification to RN of findings out of facility parameters. 11/6/23- Bp reading of 183/147 at 6:30am. No evidence of notification to RN of findings out of facility parameters. 11/8/23- Treatment record revealed 72 minutes between documented vitals checks at 9:02am and 10:14am. Treatment records also revealed 72 minutes between documented safety checks at 9:02am and 10:14am. 11/10/23- Treatment record revealed 65 minutes between documented vitals checks at 7:30am and 8:35am. Treatment records also revealed 65 minutes between documented safety checks at 7:30am and 8:35am. 11/13/23- Treatment record revealed 57 minutes between documented vitals checks at 9:33am and 10:25am. Treatment records also revealed 55 minutes between documented safety checks at 9:30am and 10:25am. MR4, Admission date10/24/23, dates reviewed 10/31/23-11/11/23. 10/31/23- Diastolic Bp reading of 115 at 6:10am and 114 at 9:39 am recorded by PCT. No evidence of notification to RN of findings out of facility parameters. Treatment record revealed 61 minutes between documented vitals checks at 7:01am and 8:02am and 91 minutes between 8:02am and 9:33am. Treatment records also revealed 60 minutes between documented safety checks at 7:00am and 8:00am and 90 minutes between 8:00am and 9:30am. 11/4/23- Treatment record revealed 60 minutes between documented vitals checks at 7:31am and 8:31am. 11/7/23- Diastolic Bp reading of 106 at 6:12am recorded by PCT. No evidence of notification to RN of findings out of facility parameters. 11/9/23- Diastolic Bp reading of 111 at 9:02am recorded by PCT. No evidence of notification to RN of findings out of facility parameters. MR5, Admission date 2/23/23, dates reviewed 11/1/23-11/13/23. 11/13/23- Treatment record revealed 68 minutes between documented vitals checks at 6:26am and 7:34am. Treatment records also revealed 64 minutes between documented safety checks at 6:26am and 7:30am. MR6, Admission date 5/30/23, dates reviewed 10/31/23-11/11/23. 10/31/23- Systolic bp reading of 91 at 7:01am, 93 at 7:30am, and 95 at 8:01am, recorded by PCT. No evidence of notification to RN of findings out of facility parameters. 11/4/23- Diastolic Bp reading of 105 at 6:02am recorded by PCT. No evidence of notification to RN of findings out of facility parameters. 11/7/23- Systolic bp reading of 95 at 6:31am, 95 at 7:02am, 92 at 7:33am, and 96 at 8:02am recorded by PCT. No evidence of notification to RN of findings out of facility parameters. 11/11/23- Treatment record revealed 50 minutes between documented vitals checks at 6:10am and 7:00am. MR7, Admission date 10/1/23, dates reviewed 10/12/23-10/26/23. 10/14/23- Systolic bp reading of 94 at 3:13pm, recorded by PCT. No evidence of notification to RN of findings out of facility parameters. 10/19/23- Systolic bp reading of 97 at 3:03pm recorded by PCT. No evidence of notification to RN of findings out of facility parameters. 10/21/23- Systolic bp reading of 81 at 3:03pm recorded by PCT. No evidence of notification to RN of findings out of facility parameters. 10/26/23- Treatment record revealed 60 minutes between documented safety checks at 12:00pm and 1:00pm. MR8, Admission date 8/2/23, dates reviewed 11/1/23-11/13/23. 11/1/23- Treatment record revealed 59 minutes between documented vitals checks at 1:32pm and 2:31pm. Treatment records also revealed 60 minutes between documented safety checks at 1:32pm and 2:32pm. 11/3/12- Treatment record revealed 58 minutes between documented vitals checks at 1:02pm and 2:00pm. Treatment records also revealed 60 minutes between documented safety checks at 1:00pm and 2:00pm. MR9, Admission date 8/2/23, dates reviewed 9/25/23-11/8/23. 10/27/23- Treatment record revealed 88 minutes between documented vitals checks at 2:32pm and 3:58pm. Treatment records also revealed 88 minutes between documented safety checks at 2:30pm and 3:58pm. 10/31/23- Treatment record revealed 50 minutes between documented vitals checks at 3:07pm and 3:57pm. Treatment records also revealed 57 minutes between documented safety checks at 3:00pm and 3:57pm. 11/3/23- Treatment record revealed 48 minutes between documented safety checks at 3:00pm and 3:48pm. Interview with Director of Operations, Center Manager, and Home Therapies Clinical Manager on November 17, 2023 at approximately 2:00pm confirmed findings. Repeat deficiency, previously cited: 12/18/17 & 4/24/19.”

“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: 42178 Based on review of facility policy, medical records (MR), and staff (EMP) interview the facility failed to ensure the blood flow rate (BFR) was administered per physician order for three (3) of nine (9) In-Center Hemodialysis records reviewed. (MR 1, 2, & 4) Findings Included: Review of facility policy on 11/16/23 at approximately 8:45am revealed: “Patient Assessment and Monitoring...During Treatment...3 Machine Parameters and Extracorporeal Circuit...Check machine settings and measurements: check prescribed blood flow is being achieved or reason is documented in the medical record if unable to meet prescribed blood flow...4 Document any findings and interventions in the medical record...” Review of MR on 11/16/3223 between approximately 9:00am and 4:00pm revealed: MR2, Admission date 6/14/23, dates reviewed 11/1/23-11/13/23. 11/13/23- Blood Flow Rate (BFR) ordered 400. BFR documented to be 300 for duration of treatment, starting at 12:03pm and ending at 3:22pm. No evidence of documentation to reflect BFR not as per order. MR3, Admission date 8/18/23, dates reviewed 11/1/23-11/13/23. 11/10/23- Blood Flow Rate (BFR) ordered 400. BFR documented to be 300 for duration of treatment, starting at 6:17am and ending at 10:14am. No evidence of documentation to reflect BFR not as per order. MR4, Admission date10/24/23, dates reviewed 10/31/23-11/11/23. 11/2/23- Blood Flow Rate (BFR) ordered 300. BFR documented to be 250 starting at 6:31am and ending with treatment at 9:42am. No evidence of documentation to reflect BFR not as per order. 11/7/23- Blood Flow Rate (BFR) ordered 300. BFR documented to be 200 starting at 6:32am and ending with treatment at 9:46am. No evidence of documentation to reflect BFR not as per order. 11/9/23- Blood Flow Rate (BFR) ordered 300. BFR documented to be 250 at 6:32am, 7:04am, and 9:35am. No evidence of documentation to reflect BFR not as per order. Interview with Director of Operations, Center Manager, and Home Therapies Clinical Manager on November 17, 2023 at approximately 2:00pm confirmed findings.”

“POC-VASCULAR ACCESS-MONITOR/REFERRALS CFR(s): 494.90(a)(5) The interdisciplinary team must provide vascular access monitoring and appropriate, timely referrals to achieve and sustain vascular access. The hemodialysis patient must be evaluated for the appropriate vascular access type, taking into consideration co-morbid conditions, other risk factors, and whether the patient is a potential candidate for arteriovenous fistula placement. This Standard is not met as evidenced by: 42178 Based on review of facility policy, Observations (OBS), and staff (EMP) interview the facility failed to ensure staff followed procedure for Post Treatment Fistula Needle Removal for two(2) of two (2) Observations of Discontinuation of Dialysis and Post Dialysis Access Care for AV Fistula or Graft conducted. (OBS 1 & 2) Findings Included: Review of facility policy on 11/16/23 at approximately 8:45am revealed: “Post Treatment Fistula Needle Removal...Procedure...8. Once hemostasis is achieved: remove the gauze...place Band-Aid, adhesive dressing, or gauze dressing secured with clean tape...” OBS 1 at station #1, conducted 11/13/23 at approximately 11:10am. EMP1 failed to visualize needle site to ensure hemostasis achieved, failed to remove gauze and place Band-Aid, adhesive dressing, or gauze dressing secured with clean tape. EMP1 placed 2 additional pieces of tape over taped gauze used to hold site. OBS 2 at station #9, conducted 11/14/23 at approximately 9:25am. EMP6 failed to visualize needle site to ensure hemostasis achieved, failed to remove gauze and place Band-Aid, adhesive dressing, or gauze dressing secured with clean tape. EMP6 placed 2 additional pieces of tape over taped gauze used to hold site. Interview with Director of Operations, Center Manager, and Home Therapies Clinical Manager on November 17, 2023 at approximately 2:00pm confirmed findings.”