Fkc Altoona

“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: 37471 Based on a review of facility policies and procedures, medical records (MR) and staff (EMP) interviews, the facility failed to ensure the evaluation of the appropriateness of the dialysis prescription for the following: blood flow rates (BFR) and for one (1) six (6) in-center hemodialysis medical records MR’s reviewed (MR1). Findings include: A review was conducted of facility policy on 4/9/2024 at approximately 9:30 AM which revealed, “Unable to Achieve Prescribed Blood Flow Rate...Actions to Achieve Prescribed Blood Flow Rate Notification, Notify physician/extender if unable to achieve prescribed blood flow rate. Documentation, Document in the treatment record what actions taken to address the inadequate blood flow and if unable to resolve. The nurse shall document any physician orders...” MR #1 admit date 4/18/2022, was reviewed on 3/26/2024, at approximately 12:14 PM. The prescribed BFR ordered by the physician and specified on the patient transfer report was 450 milliliters per minute ml/min. According to the documentation on 3/19/2024 treatment sheet the BFR did not follow the physicians order. The treatment started at 10:46 AM with a BFR of 450 ml/min. At 11:58 AM the BFR reading was 200 ml/min. The BFR reading changed to 215 ml/min at 12:13 PM and remained at 215 ml/min until 1:30 PM. There was no documentation on the date referenced, that the physician was notified the patient BFR was changed. An exit interview was conducted with the clinic manager and charge nurse on 3/28/2024 at approximately 12:00 PM that confirmed the above findings.”

“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: 37471 Based on a review of facility policy, medical records (MR) and staff (EMP) interviews, it was determined that facility failed to ensure treatments were delivered in accordance with the dialysis prescription ordered by the physician : blood flow rates (BFR) and for one (1) six (6) in-center hemodialysis medical records MR’s reviewed (MR4). Findings included: A review was conducted of facility policy on 4/9/2024 at approximately 9:30 AM which revealed, “ Unable to Achieve Prescribed Blood Flow Rate ...Actions to Achieve Prescribed Blood Flow Rate ...Notification, Notify physician/extender if unable to achieve prescribed blood flow rate. Documentation, Document in the treatment record what actions taken to address the inadequate blood flow and if unable to resolve. The nurse shall document any physician orders ... “ Review of MR4 on 3/26/2024, at approximately 1:05 PM revealed the prescribed BFR ordered by the physician and specified on the patient transfer report was 350 milliliters per minute. Review of six (6) post treatment sheets from 3/8/2024 to 3/20/2024 was conducted. According to the documentation on treatment flow sheets the BFR did not follow the physicians order for the following date: 3/8/2024 On 3/8/2024, treatment began at 12:00 PM with the prescribed BFR at 400, and remained at this rate for the remainder of the treatment. No documentation was found in the MR’s that confirmed the physician had ordered any changes to the hemodialysis order. An exit interview was conducted with the clinic manager and charge nurse on 3/28/2024 at approximately 12:00 PM that confirmed the above findings.”