Davita Allendale County Dialysis

“IC-DISINFECT SURFACES/EQUIP/WRITTEN PROTOCOL CFR(s): 494.30(a)(4)(ii) [The facility must demonstrate that it follows standard infection control precautions by implementing- (4) And maintaining procedures, in accordance with applicable State and local laws and accepted public health procedures, for the-] (ii) Cleaning and disinfection of contaminated surfaces, medical devices, and equipment. This Standard is not met as evidenced by: 41879 Based on observation, interview and review of facility policy and procedure, the dialysis clinic staff failed to follow standard infection control guidelines for cleaning dialysis machine between patients for 1 of 3 Patient Care technicians observed. (PCT #1). The findings include: Observation on 5/01/2024 at 10:35 AM of the facility treatment area revealed Patient Care Technician (PCT) #1 cleaning the dialysis machine at station #8. PCT #1 disinfected the dialysis machine with bleach cloths but failed to disinfect the prime waste container on the side of the machine. The prime waste container noted to contain approximately 1 to 2 cups of clear liquid. Further observation revealed PCT #1 then brought clean supplies to the station to set up the machine for the next patient and placed them on the chair side table. During an interview on 5/01/2024 at 10:45 AM, PCT #1 stated, “I should have cleaned the priming container. I was moving so fast”. Facility policy, entitled “Infection Control for Dialysis Facilities” revealed “ Disinfection, at the end of each treatment, the dialysis station will be cleaned and disinfected. Priming containers are to be emptied prior to disinfection”.”

“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: 41879 Based on record review, staff interview and review of facility policy and procedure, the dialysis clinic failed to ensure physician orders for the Blood Flow Rate (BFR) and Dialysis Flow Rate (DFR) was followed for 4 of 7 patient records reviewed. (Patients #2, #3, #4 and #6). The findings include: Record review on 4/29/24 at 2:49 PM of Patient #2 revealed hemodialysis treatment orders dated 3/19/2024 read, “Blood Flow Rate: 350 and Dialysis Flow Rate: 600”. Review of Pt #2’s treatment sheets revealed the following: 3/29/2024: DFR 500 4/03/2024: DFR 500 4/26/2024: BFR 300, DFR 500 Further review of the chart revealed no documentation for the changes in the physician prescription. During an interview on 5/01/2024 at 10:30 AM, the Facility Administrator verified the findings. Record review on 4/30/24 at 12:30 PM of Patient #3 revealed hemodialysis treatment orders dated 4/12/2023 read, “Blood Flow rate 350 and Dialysis Flow Rate 800”. Review of Pt #3’s treatment sheets revealed the following: 4/12/2024: DFR 500 4/17/2024: BFR 300 Further review of the chart revealed no documentation for the changes in the physician prescription. During an interview on 5/01/2024 at 10:30 AM, the Facility Administrator verified the findings. Record review on 4/30/2024 at 12:57 PM of Patient #4 revealed hemodialysis treatment orders dated 3/19/2024 read, “Blood Flow rate 350 and Dialysis Flow Rate 600”. Review of Pt #4’s treatment sheets revealed the following: 4/02/2024: DFR 500 4/06/2024: 500 4/09/2024: 500 4/25/2024: 500 Further review of the chart revealed no documentation for the changes in the physician prescription. During an interview on 5/01/2024 at 10:30 AM, the Facility Administrator verified the findings. Record review on 5/1/24 at 9:22 AM of Patient # 6 revealed hemodialysis treatment orders dated 4/03/2024 read, “Blood Flow Rate 500 and Dialysis Flow Rate 800”. Review of Pt #6’s treatment sheets revealed the following: 4/08/2024: DFR 500 4/22/2024: DFR 500 4/23/2024: BFR 300-325 4/25/2024: BFR 350 4/26/2024: DFR 500 Further review of the chart revealed no documentation for the changes in the physician prescription. During an interview on 5/01/2024 at 10:30 AM, the Facility Administrator verified the findings. Facility policy, entitled “CWOW-PRE-INTRA-POST TREATMENT DATA COLLECTION, MONITORING AND NURSING ASSESSMENT,” revealed “If the dialysis prescription is not being met (including dialysis flow rate or change to/inability to obtain blood flow rate) the reason will be documented and the licensed nurse informed”.”