Fresenius Kidney Care Lincoln

“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: 41729 46715 Based on staff interview and record review, it has been determined that the facility failed to ensure that staff follow the 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) prescription when administering HD treatments for 3 of 5 patients reviewed, Patient ID #s 1, 4, and 5. 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 treatment record what action 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 #1 was admitted to the facility in January of 2025 with a diagnosis including, but not limited to, acute kidney injury and is receiving HD three times per week. Further review of the record revealed the patient’s current dialysis prescription order is for a dialysate (an electrolyte solution used in hemodialysis) flow rate (DFR) of 700 milliliter/minute (ml/min) and a blood flow rate (BFR, the speed that the patient’s blood is moving through the dialysis tubing) of 350 ml/min. During a surveyor observation on 7/22/2025 at 12:10 PM in the presence of Clinic Manager, Staff A, the patient was receiving dialysis with a blood flow rate of 300 ml/min. During an interview directly following the above observation with Staff A, he was unable to provide rationale as to why the patients blood flow rate was at 300 ml/min and not at the prescribed 350 ml/min. Review of the dialysis treatment flow sheets revealed that Patient ID #1 received his/her treatment with a BFR less than the ordered 350 ml/min on the following dates: - 7/12/2025 with a BFR of 345 ml/min - 7/22/2025 with a BFR of 300 Further review of the record failed to reveal evidence that the physician was notified that Patient ID #1 did not receive his/her dialysis treatments as ordered, a rationale as to why the BFR was adjusted, or what actions were taken to address the inadequate blood flow. 2. Record review revealed Patient ID #4 was admitted to the facility in September of 2019 with a diagnosis including, but not limited to, end stage renal disease and is receiving HD three times per week. Further review of the record revealed the patient’s current dialysis prescription order is for a DFR of 700 ml/min and BFR of 450 ml/min. Review of the dialysis treatment flow sheets revealed that Patient ID #4 received his/her treatment with a BFR of 300 ml/min on 7/10/2025. Further review of the record failed to reveal evidence that the physician was notified that Patient ID #4 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. 3. Record review revealed Patient ID #5 was admitted to the facility in October of 2022 with a diagnosis including, but not limited to, complication of a kidney transplant and is receiving HD three times per week. Further review of the record revealed that Patient #5’s current dialysis prescription order is for a DFR of 800 ml/min and BFR of 450 ml/min. Review of the dialysis treatment flow sheets revealed that Patient ID #5 received his/her treatment with a BFR of 400 ml/min on 7/11/2025. Further review of the record failed to reveal evidence that the physician was notified that Patient ID #5 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. During a surveyor interview on 7/23/2025 at approximately 2:20 PM with Clinic Manager, Staff B, she acknowledged that the above noted patients blood flow rates were not followed as ordered. Additionally, she was unable to provide evidence of the rationale as to why the BFR was adjusted.”

“PQ-STAFF NURSE-MEET STATE REQUIREMENTS CFR(s): 494.140(b)(4) Each nurse who provides care and treatment to patients must be either a registered nurse or a practical nurse who meets the practice requirements in the State in which he or she is employed. This Standard is not met as evidenced by: 41729 Based on record review and staff interview, it has been determined that the facility failed to ensure that each nurse who provides care and treatment to patients meets the practice requirements in the state in which he or she is employed for 1 of 2 staff reviewed, Staff C. Findings are as follows: Record review revealed Staff C was hired as a full time Registered Nurse (RN) on 8/21/2023. Further record review of Staff C’s personnel record revealed her license had an expiration date of 3/1/2025. Record review revealed Staff C has worked at the facility as a full time RN since 3/1/2025 after the expiration date of her license. Review of the Rhode Island Department of Health license verification page on 7/23/2025 at 11:50 AM revealed Staff C’s RN license had expired as of 3/1/2025. During a surveyor interview on 7/24/2025 at 10:45 AM with Staff C, she acknowledged that her license had an expiration date of 3/1/2025. During surveyor interviews on 7/23/2025 at 11:55 AM and on 7/24/2025 at 10:07 AM with Clinic Manager, Staff B, she acknowledged that Staff C has worked at the facility as a full time RN since 3/1/2025. She further acknowledged that she was unaware that Staff C’s license had expired until it was brought to her attention by the surveyor on 7/23/2025.”