Fresenius Medical Care of Warwick

“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: 47279 Based on record review and staff interview, it has been determined that the facility failed to ensure that staff follow the prescription for hemodialysis (HD, a procedure where a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean the blood) when administering HD treatments for 4 of 10 patients reviewed, Patient ID #s 9, 10, 11, and 12. Findings are as follows: Review of a facility policy titled, “Unable to Achieve Prescribed Blood Flow Rate” dated 11/1/2021, states in part, “...Notify physician/extender if unable to achieve prescribed blood flow rate...Document in patients [sic] treatment record what action [was] taken to address the inadequate blood flow and if unable to resolve. The nurse shall document any physician orders...” 1. Record review revealed Patient ID #9 was admitted to the facility in September of 2024 with a diagnosis including, but not limited to, end stage renal disease and is receiving HD three times per week. Further record review revealed the patient’s current dialysis prescription order is for a dialysate (an electrolyte solution used in hemodialysis) flow rate (DFR) of 800 milliliter/minute (ml/min) and a blood flow rate (BFR, the speed that the patient’s blood is moving through the dialysis tubing) of 450 ml/min. Review of the dialysis treatment flow sheets revealed that Patient ID #9 received his/her treatment with a BFR of 300 ml/min on 8/20/2025. Record review failed to reveal evidence that the physician was notified that Patient ID #9 did not receive his/her dialysis treatment as ordered, a rationale as to why the BFR was adjusted, or what actions were taken to address the inadequate blood flow rate. 2. Record review revealed Patient ID #10 was admitted to the facility in April of 2021 with a diagnosis including, but not limited to, end stage renal disease and is receiving HD three times per week. Further record review revealed the patient’s current dialysis prescription order is for a DFR of 800 ml/min and a blood flow rate BFR of 450 ml/min. Review of the dialysis treatment flow sheets revealed that Patient ID #10 received his/her treatment with a BFR more than the ordered 450 ml/min on the following dates: - 8/13/2025 with a BFR of 500 ml/min - 8/18/2025 with a BFR of 500 ml/min Record review failed to reveal evidence that the physician was notified that Patient ID #10 did not receive his/her dialysis treatments as ordered or a rationale as to why the BFR was higher than prescribed. 3. Record review revealed Patient ID #11 was admitted to the facility in October of 2024 with a diagnosis including, but not limited to, end stage renal disease and is receiving HD three times per week. Further record review revealed that Patient ID #11’s current dialysis prescription order is for a DFR of 800 ml/min and a BFR of 350 ml/min. Review of the dialysis treatment flow sheets revealed that Patient ID #11 received his/her treatment with a BFR of 300 ml/min on 8/12/2025. Record review failed to reveal evidence that the physician was notified that Patient ID #11 did not receive his/her dialysis treatment as ordered, a rationale as to why the BFR was adjusted, or what actions were taken to address the inadequate blood flow rate. 4. Record review revealed Patient ID #12 was admitted to the facility in May of 2025 with a diagnosis including, but not limited to, end stage renal disease and is receiving HD three times per week. Further record review revealed that Patient ID #12’s current dialysis prescription order is for a DFR of 800 ml/min and a BFR of 450 ml/min. Review of the dialysis treatment flow sheets revealed that Patient ID #12 received his/her treatment with a DFR of 500 on 8/16/2025 and a BFR of 300 ml/min on 8/21/2025. Record review failed to reveal evidence that the physician was notified that Patient ID #12 did not receive his/her dialysis treatments as ordered, a rationale as to why the BFR and DFR were adjusted, or what actions were taken to address the inadequate blood and dialysate flow rates on the above-mentioned dates. During a surveyor interview on 8/28/2025 at 11:21 AM with the Clinic Manager, she acknowledged that the above noted patients’ dialysis treatment prescription orders including the BFR and DFR were not followed as prescribed on the above-mentioned dates. Additionally, she was unable to provide evidence of the rationales as to why the BFRs and/or DFRs were adjusted and would expect the rationales for the adjustments to be documented.”