Dci Archdale

“IC-WEAR GLOVES/HAND HYGIENE CFR(s): 494.30(a)(1) Wear disposable gloves when caring for the patient or touching the patient’s equipment at the dialysis station. Staff must remove gloves and wash hands between each patient or station. This Standard is not met as evidenced by: 41879 Based on observations, staff interview and facility policy, “Infection Control for Dialysis Facilities,” the dialysis facility staff failed to follow standard infection control practices to prevent cross contamination for one of three Patient Care Technicians (PCT’s) observed and one of three Registered Nurses (RN’s) observed. (PCT #3) (RN #6) The findings are: On 08/19/24 at 3:10 PM observations are done in the treatment area of the in-center hemodialysis patients. PCT #3 is observed at dialysis station #4 touching the dialysis machine screen and touching the side of the dialysis machine without gloves on. PCT #3 taps the dialysis machine screen three to four times, touches the side of the machine to move the dialysis machine slightly and then is observed using the computer next. No hand hygiene is observed during any of the contact noted with the dialysis machine and/or keyboard. On 08/20/24 at 12:25 PM, PCT #3 verified the findings. On 08/22/24 at 11:30 AM observations are done in the facility’s peritoneal dialysis home area. RN #6 is noted drawing up Venofer to administer Intravenous(IV). RN #6 dons clean gloves, draws up the medication into a syringe, doffs the gloves and dons another pair of new gloves. RN #6 prepares a bag of fluids, infusing the iron into the bag of fluids from the syringe, finishes medication preparation and doffs the gloves. RN #6 then dons another new pair of gloves. No hand hygiene observed prior to and/or after glove changes. On 08/22/24 at 12:10 PM, RN #6 verified the findings. Facility policy, entitled, “Infection Control For Dialysis Facilities,” reads, “Hand Hygiene is to be performed upon entering the patient treatment area, prior to gloving, after removal of gloves, after contamination with blood or infectious material, after patient and dialysis delivery system contact, between patients even if the contact is casual, and before touching clean areas such as supplies.””

“IC-CLEAN/DIRTY;MED PREP AREA;NO COMMON CARTS CFR(s): 494.30(a)(1)(i) Clean areas should be clearly designated for the preparation, handling and storage of medications and unused supplies and equipment. Clean areas should be clearly separated from contaminated areas where used supplies and equipment are handled. Do not handle and store medications or clean supplies in the same or an adjacent area to that where used equipment or blood samples are handled. When multiple dose medication vials are used (including vials containing diluents), prepare individual patient doses in a clean (centralized) area away from dialysis stations and deliver separately to each patient. Do not carry multiple dose medication vials from station to station. Do not use common medication carts to deliver medications to patients. If trays are used to deliver medications to individual patients, they must be cleaned between patients. This Standard is not met as evidenced by: 41879 Based on observations, staff interview and facility policy, “General Facility Infection Control,” the dialysis facility staff failed to handle clean supplies using standard infection control practices to prevent cross contamination for one of three Registered Nurse (RN) observed. (RN #1) The findings include: On 08/19/24 at 3:25 PM observations in the treatment area revealed RN #1 at Station #10 with a patient. RN #1 prior to starting dialysis on the patient whose dialysis lines are connected and awaiting the initiation of treatment, obtained a new bag of intravenous fluids (IV) to replace an empty normal saline bag attached to the machine. RN #1 placed the new bag of IV fluids on top of the dialysis machine, donned a pair of new clean gloves, takes the bag of IV fluids off the top of the dialysis machine, opens the package and changes the empty IV fluid bag with the new IV fluids with possible contamination from the gloves to the IV fluids post exchange. On 08/20/24 at 10:10 AM, RN #1 verified the findings. Facility policy, entitled “General Facility Infection Control,” reads, “Do not handle and store medications or clean supplies in the same area or an adjacent area to that where used equipment or blood samples are handled.””

“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: 41879 Based on observations, staff interview and facility policy, “Infection Control for Dialysis Facilities,” the dialysis facility staff failed to check and removed expired supplies from the patient care areas. The findings are: On 08/19/24 at 2:33 PM a tour of the dialysis facility revealed six bottles of 16 ounce Mesa Labs conductivity solutions expired 08/17/24 and (1) bottle of Myron and Company pH solution expired on 05/24/24. On 08/19/24 at 3:30 PM, the Clinic Manager verified the findings. Facility policy, entitled “Infection Control for Dialysis Facilities,” reads, “Supplies must be rotated First in -First Out (FIFO) to ensure products maintain quality and do not expire. Appropriately dispose of items that have reached the expiration date”.”

“PA-ASSESS B/P, FLUID MANAGEMENT NEEDS CFR(s): 494.80(a)(2) The patient’s comprehensive assessment must include, but is not limited to, the following: Blood pressure, and fluid management needs. This Standard is not met as evidenced by: 41879 Based on record review and staff interview, the dialysis facility staff failed to monitor patients every thirty minutes for and notification to a nurse for decreased vital signs for one of six in-center hemodialysis patients (Patient #2). The findings include: On 08/20/24 at 10:25 AM the dialysis treatment sheets for Patient #2 are reviewed. Review of dialysis treatment sheet dated 08/01/24 at 8:00 AM revealed Patient #2’s blood pressure (BP) was 71/28. The next BP for Patient #2 was documented at 9:00 AM as 69/32, which is one hour between blood pressure checks and/or any documented notification to a nurse regarding the low reading. During an interview on 08/22/24 at 2:30 PM, the Clinic Manager reviewed the treatment sheet and stated, “We always get vitals every thirty minutes and with a low BP we should get the vitals more frequently. The technician should have documented they notified the RN with a BP that low.””

“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 facility policy, “CWOW-PRE-INTRA-POST TREATMENT DATA COLLECTION, MONITORING AND NURSING ASSESSMENT,” the dialysis facility staff failed to follow physician orders for the Dialysis Flow Rate (DFR) for one of six in-center hemodialysis patient records reviewed. (Patient #4) The findings are: A review of Patient #4’s treatment sheets on 08/19/24 at 12:49 PM revealed two of ten treatment sheets documented incorrect dialysis flow rate (DFR). “Hemo (hemodialysis) Treatment Orders” dated 06/04/24 read, “Blood Flow Rate: 200 and Dialysis Flow Rate: 350.” Review of dialysis treatment sheet dated 08/14/24 revealed Patient #4’s dialysis treatment started at 10:45 AM with a DFR of 610. The DFR ran at 610 the entire treatment which ended at 1:40 PM with no reason documented for the elevated DFR. Review of dialysis treatment sheet dated 08/19/24 revealed Patient #4’s dialysis treatment started at 10:22 AM with a DFR of 650. The DFR is decreased to 360 at 10:43 AM and continued at a DFR of 360 until the end of treatment at 1:53 PM with no reason documented for the changes of the DFR. On 08/22/24 at 1:00 PM, the Clinic Manager verified the findings. Facility policy, entitled “CWOW-PRE-INTRA-POST TREATMENT DATA COLLECTION, MONITORING AND NURSING ASSESSMENT,” reads, “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.””