Davita Heritage Lake 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: 39848 Based on reviews of observations, facility policy, and an interview with the facility administrator, the facility failed to ensure proper inventory control for four (4) of four (4) observations (Observation #1-#4). Findings include: Review of Davita inc. Incenter Hemodialysis Policies and Procedures: Title: Medication Policy: “ Purpose: To provide guidance for medication management in the facility and to provide guidance for the safe and aseptic preparation of all medications; Policy: 1. The Facility Administrator/designee is responsible for supervising the handling, storing, disposing, administering, and controlling of medications and performs monthly audit and inventory; 13. All open or unopened medication packages (i.e. vials, ampules, etc) are stored according to the manufacturer ’ s directions. Do not use any medication that has been stored improperly or has expired; 30. All medications in the facility are checked monthly for expiration dates; 32. Disposal of expired medications, including all over the counter and nutritional product samples are removed from the treatment and inventory areas and disposed of per state/local regulations. “ Review of Davita inc. Incenter Hemodialysis Policies and Procedures: Title: “ Infection Control for dialysis facilities: “ Purpose: To minimize the spread of infections or bloodborne pathogens in the dialysis facility environment.; Policy: The Center for Disease Control (CDC) recommendations for preventing transmission of infections among chronic hemodialysis patients (dialysis precautions) will be followed when caring for all patients. Supplies: 8. Supplies will be stored in a manner that maintains their integrity. b. expiration date and package integrity will be verified prior to use. Observations conducted in the center’s medication area drawers on 3/18/24 between approximately 3:30 PM-3:50 PM revealed the following: Observation (OBS) #1 revealed: Eighty-six (86) BD Precision glide needle twenty-one (21) gauge by one (1) inch with expiration date of 9/30/2023. OBS # 2 revealed: Eighty-one (81) BD Precision glide needle twenty-one (21) gauge by one (1) inch with expiration date of 12/31/2022. OBS # 3 revealed: Thirty-one (31) BD Eclipse needle twenty-two (22) gauge by one and a half (1.5) inch with expiration date of 5/31/2022. OBS # 4 revealed: One (1) BD Eclipse needle twenty-two (22) gauge by one and a half (1.5) inch with expiration date of 8/31/2020. An interview conducted with the Facility Administrator on 3/18/24 at approximately 3:50 PM 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: 39848 Based on review of medical records (MR), policies and procedures and interviews with facility clinical manager and facility administrator, it was determined that the facility failed to adequately monitor prescribed blood flow and dialysate flow rates during treatment in three (3) of four (4) MR reviewed (MR # 1, # 3 and # 4) and the facility failed to ensure prescibed treatment times were achieved in two (2) of four (4) MR reviewed. (MR # 2 and # 4) Findings: Review of Davita inc. Incenter Hemodialysis Policies and Procedures: Title: Pre-Intra-post treatment data collection, monitoring and nursing assessment: “ Purpose: To obtain and document baseline and ongoing information about the patient before, during and after the dialysis treatment through data collection and nursing assessment. This information will be used in planning and documenting the patient ’ s dialysis treatment, monitoring during treatment and for reviewing the patient ’ s response to the treatment and status prior to discharge.; Policy: 1. Patient data will be obtained and documented by the patient care technician (PCT) or a licensed nurse; 2. The nursing assessment will be performed and documented by a licensed nurse ....a. the assessment includes the following components: iii. Verification of prescription including machine parameters; 3. Patient identity, prescription and machine settings are verified by teammate prior to initiation of treatment with the exception of blood flow rate which is verified and documented when the ordered rate is obtained after onset of treatment. The prescription components are confirmed by a licensed nurse within one (1) hour of treatment initiation ...; Prescription components include but are not necessarily limited to: f. blood flow rate (BFR); g. dialysate flow rate (DFR); Intradialytic data collection/assessment: 9. Intradialytic treatment monitoring and data collection ....includes: b. At a minimum, obtain and document the following: iii. Blood and dialysate flows, arterial and venous pressures; 10. If the dialysis prescription is not being met (including dialysis flow rate or change to/inability to obtain prescribed blood flow rate), the reason will be documented, and the licensed nurse informed. 11. Abnormal findings or findings outside of any patient specific physician ordered parameters will be reported to the licensed nurse immediately ... “ Review of Davita inc. Incenter Hemodialysis Policies and Procedures: Title: Prescribed treatment time not met: Purpose: To provide requirements for teammates to follow when a patient ’ s treatment is terminated early.; Policy: “ a. completion of the early termination of treatment against medical advice form: 1. The Registered Nurse (RN) will verify that a patient signs the early termination of treatment against medical advice form any time the patient requests to terminate their treatment earlier than the prescribed run time. 3. The RN will obtain the patient ’ s signature ...4. A RN must countersign all early termination of treatment against medical advice forms. A witness signature is required only if the patient refuses to sign the form. B. Prescribed treatment time not met: 1. If shortened/early termination of treatment exceeds thirty (30) or more minutes, the RN will notify the patient ’ s attending nephrologist to discuss the appropriate intervention ...; Note: Shortened/early termination of the dialysis treatment includes all reasons the prescribed dialysis time is not met by thirty (30) or more minutes. This includes but is not limited to: the late initiation of treatment with termination at scheduled time, early termination at the end of treatment and interruptions of dialysis during the treatment (i.e. machine or access problems or use of the bathroom by the patient) ... “ Review of Davita inc. Incenter Hemodialysis Policies and Procedures: Title: Early termination of treatment against medical advice form revealed: “ I, Patient ’ s name, request to terminate my dialysis treatment prior to the prescribed time. I am fully aware that this is against the medical advice of my physician. The risk and consequences of terminating my treatment early have been explained to me ...I hereby willfully assume the risk of my early termination of dialysis treatment and agree not to hold my physician, the dialysis facility, it ’ s employees or agents responsible for any harm or injury which may result from my action. “ Review of medical records (MR) on 3/20/24 between 10:15 AM-10:55 AM and 11:10 AM and 12: 30 PM revealed: MR # 1: Start of care (SOC): 2/7/23; Review of treatment flow sheets from 3/7/24-3/19/24 revealed: a. Dialysis prescription dated 3/5/24: Treatment time: three (3) hours thirty (30) minutes (two hundred ten (210) minutes; Blood flow rate (BFR): four hundred (400) milliliters per minute; Dialysate flow rate (DFR): six hundred (600) milliliters per minute; Dialysate: one (1) potassium (K), two (2) and a half (0.5) calcium (Ca) acid-dry, Granuflo; ordered target weight: ninety-eight (98.0) kilograms (kg) or two hundred sixteen and one tenth (216.1) pounds (lbs) b. Treatment flow sheet from 3/7/24: Prescribed Blood flow rate (BFR): four hundred (400);Dialysate flow rate (DFR): six hundred (600): BFR from 8:01 AM through 11:27 AM: three hundred fifty (350) to three hundred sixty (360). c. Treatment flow sheet from 3/9/24: Prescribed Blood flow rate (BFR): four hundred (400); Dialysate flow rate (DFR): six hundred (600): BFR from 7:46 AM through 11:23 AM: three hundred fifty (350). d. Treatment flow sheet from 3/12/24: Prescribed Blood flow rate (BFR): four hundred (400);Dialysate flow rate (DFR): six hundred (600): BFR from 7:54 AM through 11:24 AM: ranged between three hundred fifty (350) to three hundred (300). e. Treatment flow sheet from 3/14/24: Prescribed Dialysate flow rate (DFR): six hundred (600): DFR from 8:31 AM through 11:32 AM: ranged between five hundred ninety (590) through six hundred twenty (620) f. Treatment flow sheet from 3/16/24: Prescribed Blood flow rate (BFR): four hundred (400); Dialysate flow rate (DFR): six hundred (600): BFR from 7:52 AM through 11:25 AM: three hundred (300); DFR from 8:52 AM through 10:22 AM: ranged between five hundred ninety (590) through six hundred twenty (620). g. Treatment flow sheet from 3/19/24: Prescribed Blood flow rate (BFR): four hundred (400); Dialysate flow rate (DFR): six hundred (600): BFR from 7:52 AM through 11:22 AM: three hundred fifty (350); DFR from 8:22 AM through 11:22 AM: ranged between five hundred ninety (590) through six hundred twenty (620) MR # 2: Start of care (SOC): 5/25/22; Review of treatment flow sheets from 3/6/24-3/18/24 revealed: a. Dialysis prescription dated 3/5/24: Treatment time: four (4) hours (two hundred forty (240) minutes; Blood flow rate (BFR): three hundred (300) milliliters per minute; Dialysate flow rate (DFR): five hundred (500) milliliters per minute; Dialysate: two (2) potassium (K), two (2) and a half (0.5) calcium (Ca) acid-dry, Granuflo; ordered target weight: forty-six and a half (46.5) kilograms (kg) or one hundred two and a half (102.5) pounds (lbs) b. Treatment flow sheet from 3/8/24: Prescribed Treatment time: Four (4) hours or two hundred forty (240) minutes; post-treatment vitals revealed: Treatment duration: three (3) hours and thirty-two (32) minutes or two hundred twelve (212) minutes; treatment shortened by twenty-eight (28) minutes with no documentation of why treatment was shortened. c. Treatment flow sheet from 3/11/24: Prescribed Treatment time: Four (4) hours or two hundred forty (240) minutes; post-treatment vitals revealed: Treatment duration: three (3) hours and thirty-two (32) minutes or two hundred twelve (212) minutes; treatment shortened by twenty-eight (28) minutes with no documentation of why treatment was shortened. d. Treatment flow sheet from 3/13/24: Prescribed Treatment time: Four (4) hours or two hundred forty (240) minutes; post-treatment vitals revealed: Treatment duration: three (3) hours and thirty-one (31) minutes or two hundred eleven (211) minutes; treatment shortened by twenty-nine (29) minutes with no documentation of why treatment was shortened. MR # 3: Start of care (SOC): 12/24/20; Review of treatment flow sheets from 3/7/24-3/19/24 revealed: a. Dialysis prescription dated 12/2/23: Treatment time: three (3) hours (one hundred eighty (180) minutes; Blood flow rate (BFR): three hundred (300) milliliters per minute; Dialysate flow rate (DFR): five hundred (500) milliliters per minute; Dialysate: two (2) potassium (K), two (2) and a half (0.5) calcium (Ca) acid-dry, Granuflo; ordered target weight: ninety-eight (98.0) kilograms (kg) or two hundred sixteen and one tenth (216.1) pounds (lbs) b. Treatment flow sheet from 3/12/24: Prescribed Dialysate flow rate (DFR): five hundred (500): DFR from 8:43 AM through 11:43 AM: ranged between six hundred ninety (600) through six hundred ten (610). c. Treatment flow sheet from 3/14/24: Prescribed Blood flow rate (BFR): three hundred (300): BFR from 10:20 AM through 10:50 AM: two hundred fifty (250). MR # 4: Start of care (SOC): 2/15/21; Review of treatment flow sheets from 3/7/24-3/19/24 revealed: a. Dialysis prescription dated 11/12/22: Treatment time: three (3) hours and thirty (30) minutes (two hundred ten (210) minutes; Blood flow rate (BFR): three hundred and fifty (350) milliliters per minute; Dialysate flow rate (DFR): seven hundred (700) milliliters per minute; Dialysate: three (3) potassium (K), two (2) and a half (0.5) calcium (Ca) acid-dry, Granuflo; ordered target weight: ninety-seven (97.0) kilograms (kg) or two hundred thirteen and nine tenths (213.9) pounds (lbs) b. Treatment flow sheet from 3/7/24: Prescribed Dialysate flow rate (DFR): seven hundred (700): DFR from 10:50 AM through 11:20 AM: seven hundred ten (710). c. Treatment flow sheet from 3/9/24: Prescribed Blood flow rate (BFR): three hundred fifty (350): BFR from 9:46 AM through 11:46 AM: three hundred (300). d. Treatment flow sheet from 3/12/24: Prescribed Blood flow rate (BFR): thirty hundred fifty (350): BFR from 9:44 AM through 12:48 PM: ranged between two hundred (200) through three hundred (300). Prescribed Dialysate flow rate (DFR): seven hundred (700); DFR from 9:44 AM through 10:44 AM ranged between five hundred seventy (570) through seven hundred twenty (720). e. Treatment flow sheet from 3/14/24: Prescribed Dialysate flow rate (DFR): seven hundred (700): DFR from 8:32 AM through 11:32 AM: ranged between seven hundred ten (710) through seven hundred twenty (720). f. Treatment flow sheet from 3/16/24: Prescribed Dialysate flow rate (DFR): seven hundred (700): DFR from 8:36 AM through 10:36 AM: ranged between five hundred ninety (590) through seven hundred ten (710). g. Treatment flow sheet from 3/7/24: Prescribed Treatment time: Three (3) hours and thirty (30) minutes or two hundred ten (210) minutes; post-treatment vitals revealed: Treatment duration: three (3) hours and one (1) minute or one hundred eighty-one (181) minutes; treatment shortened by thirty (30) minutes with no documentation of why treatment was shortened. h. Treatment flow sheet from 3/12/24: Prescribed Treatment time: Three (3) hours and thirty (30) minutes or two hundred ten (210) minutes; post-treatment vitals revealed: Treatment duration: three (3) hours and five (5) minutes or one hundred eighty-five (185) minutes; treatment shortened by twenty-five (25) minutes with no documentation of why treatment was shortened. An interview conducted with the Facility Administrator on 3/20/24 at approximately 2:00 PM confirmed the above findings.”