Davita Wofford at Home

“IC-SANITARY ENVIRONMENT CFR(s): 494.30 The dialysis facility must provide and monitor a sanitary environment to minimize the transmission of infectious agents within and between the unit and any adjacent hospital or other public areas. This Standard is not met as evidenced by: 28883 Based on observations, interviews, and review of the facility policies “Infection Control for Dialysis Facilities”, Patient Care Technician (PCT) #2, one of two Patient Care Technicians observed discontinuing a patient treatment, failed to ensure a sanitary environment to prevent potential cross contamination due to patients’ contact with a contaminated scale button. One of two Registered Nurses observed discontinuing a patient treatment, Registered Nurse (RN) #1, failed to disinfect the saline port of the dialysis line before connecting the arterial line for rinse back of the patient’s blood. The saline port had been left uncapped with blood on the end exposed to air and at risk for the potential introduction of potential pathogens. The findings included: Observations on 2/13/24 at 9:30 AM revealed a patient at dialysis machine #1 in dialysis station #9 holding pressure to the needle sites to stop the bleeding wearing a glove. At 9:37 AM, Patient Care Technician #2 taped up the needle sites. PCT #2 did not remind/encourage the patient to perform hand hygiene. The patient removed the soiled glove and went to the scale. The patient did not perform hand hygiene after removing the soiled glove and touched the scale button to get a printout of post treatment weight. The patient did not perform hand hygiene before leaving the dialysis treatment room. The scale button was not cleaned/disinfected after potential contamination. Observations on 2/13/24 at 10:14 AM revealed a random patient washed his/her hands at the sink, but pressed the button on the scale to get a printout of the post treatment weight. Observations on 2/13/24 at 10:18 AM revealed a random patient entering the dialysis treatment room in a wheelchair. The random patient washed his/her hands and the access site at the sink, but went to the scale that had not been cleaned or disinfected and pressed the button on the scale and retrieved a printout of his/her pre-treatment weight. During an interview on 2/13/24 at 11:30 AM, Patient Care Technician #2 was informed that the patient whose dialysis treatment that she/he discontinued did not perform hand hygiene, but touched the scale button. Two random patients had been observed either entering for dialysis treatment or leaving after dialysis treatment touched the potentially contaminated scale button. On 2/14/24 at 10:42 AM, review of the facility policy, “Infection Control for Dialysis Facilities” revealed patients would be encouraged to perform hand hygiene after treatment and before leaving the treatment area. Observations on 2/13/24 at 10:06 AM revealed a random patient dialyzing at dialysis machine #4 in dialysis station #7. The saline line was clamped but uncapped on the end and exposed to the air with the potential for touch contamination. Observations again at 2/13/24 at 10:47 AM revealed the saline line clamped but uncapped with a red substance (blood) at the end of the line and exposed to air and potential contamination. Observation on 2/13/24 at 11:16 AM revealed the patient’s treatment being discontinued. Registered Nurse (RN) #1 did not disinfect the saline port before attaching the arterial line to the end, and unclamping the saline line and starting the rinse back of blood with saline through the dialysis lines. Leaving the saline line uncapped with blood on the end of the port and did not disinfect the saline port before attaching the arterial line increased the potential risk of introduction of potential pathogens into the dialysis lines. During an interview on 2/13/24 at 11:32 AM, RN #1 verified the observation.”

“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: 28883 Based on observations, interview, and review of the facility “Medication Policy”, Registered Nurse (RN) #1, one of two Registered Nurses observed for medication administration failed to perform hand hygiene after touching potentially contaminated surfaces and prior to pushing intravenous (IV) Heparin. The findings included: Observations on 2/13/24 at 10:44 AM revealed Registered Nurse (RN) #1 at dialysis machine #5 in dialysis station #3 wheeled the patient’s wheelchair and walker away from the dialysis station wearing gloves. Without performing hand hygiene or changing gloves, RN #1 administered the patient’s Intravenous Heparin (blood thinner). During an interview on 2/13/24 at 11:32 AM, RN #1 verified the observation. Review on 2/14/24 at 10:42 AM of the facility policy, titled, “Medication Policy” revealed that all teammates administering medications must utilize aseptic technique.”

“DIALYS PROPORT-MONITOR PH/CONDUCTIVITY CFR(s): 494.40(a) 5.6 Dialysate proportioning: monitor pH/conductivity It is necessary for the operator to follow the manufacturer’s instructions regarding dialysate conductivity and to measure approximate pH with an independent method before starting the treatment of the next patient. This Standard is not met as evidenced by: 28883 Based on observations, interview, and review of the facility policy, “Testing pH of Citric Acid Base Dialysate Using RPC E-Z Check K100-0117CT 6.8-8.5 Test Strips”, Patient Care Technician (PCT) #1, one of three PCTs observed performing a pH test of dialysate failed to perform the test correctly by not following the timeframe to dip the strip in dialysate and the timeframe to wait before reading. The findings included: Observations on 2/12/24 at 12:00 Noon revealed Patient Care Technician (PCT) #1 peforming an independent check of the dialysate pH for a random patient at dialysis machine #5 in dialysis station #3. PCT #1 swished the test strip in the dialysate solution for 7 seconds, flicked the dialysate from the strip, and read the test strip immediately. Review of the instructions on the bottle of pH test strips on 2/12/24 at 12:01 PM revealed a 1 second dip of the test strip in dialysate, and then a wait time of 10 seconds before comparing the color on the strip to a color on the bottle. During an interview on 2/12/24 at 12:37 PM, when PCT #1 was asked how she/he had done the test, PCT #1 stated she/he had swished the test strip in the dialysate for 10 seconds and then read the test strip. Review on 2/14/24 at 10:44 AM of the facility policy, “Testing pH of Citric Acid Base Dialysate Using RPC E-Z Check K100-0117CT 6.8-8.5 Test Strips”, revealed staff are to dip the test strip in the solution for one second, shake off the excess dialysate from the strip, and at 10 seconds, immediately compare the color reaction on the strip to the color chart on the bottle.”

“PQ-STAFF LIC AS REQ/QUAL/DEMO COMPETENCY CFR(s): 494.140 All dialysis facility staff must meet the applicable scope of practice board and licensure requirements in effect in the State in which they are employed. The dialysis facility’s staff (employee or contractor) must meet the personnel qualifications and demonstrated competencies necessary to serve collectively the comprehensive needs of the patients. The dialysis facility’s staff must have the ability to demonstrate and sustain the skills needed to perform the specific duties of their positions. This Standard is not met as evidenced by: 28883 Based on observations, interviews, and record reviews, the dialysis clinic nursing staff failed to ensure the clinic had physician orders for the administration of Phosphorous binders during dialysis for Patient #2 (1 of 5 patients reviewed for medication administration), and that the medications had been accurately dispensed/labeled by the pharmacy with the patient’s name, name of medication, dosage, route, and time for administration. The dialysis clinic failed to ensure unlicensed Patient Care Technicians did not use the Cryodose anesthetic spray on patients and that patients had physician orders for the use of the anesthetic spray. The findings included: Observations on 2/12/24 at 11:18 AM of a medication storage drawer in the dialysis treatment room revealed two plastic bags with “Patient #2” written in black ink. One bag contained 7 lime green/white colored capsules with no name of the medication and 12 large plain white pills written in black ink “Renvela”. In the second baggie was 8 white pills written in black ink was “Renvela”. There was no dosage information for either medication and the green/white colored capsules was not identified. There was no pharmacy label to indicate the medication had been dispensed by a pharmacist. During an interview on 2/12/14 at 11:20 AM, Registered Nurse (RN) #2 stated the medication was the binders for Patient #2 and had been provided by the nursing home. RN #2 stated the dialysis nursing staff gives the medication to the patient during dialysis when she/he eats. RN #2 stated the white pills are Renvela and the green/white colored capsules that were not labeled are Calcium Acetate. RN #2 stated the patient is blind and so the nursing home staff pops the pills out of a card and puts them in a baggie for dialysis nurses to give. Review on 2/13/24 at 3:30 PM of Patient #2’s medical record revealed no physician orders for the dialysis nursing staff to give the binders at dialysis and no documentation on the patient’s dialysis treatment sheets or in the nursing notes for the administration of the medication(s) to the patient during dialysis for the past 10 dialysis treatments. Review on 2/15/24 of the transfer sheet/documentation sent with the patient from the nursing home on 2/15/24 revealed no physician orders/Medication Administration Record from the nursing home for the patient to receive the binders at dialysis. Observations on 2/14/24 at 8:45 AM revealed Patient Care Technician (PCT) #4 spraying Cryodose topical anesthetic spray onto a patient’s arm (Patient #6). During an interview on 2/14/24 at 8:55 AM, Registered Nurse (RN) #1 stated that all patients have standing orders for the anesthetic spray in case they need it. Patient Care Technician #1 who was also present stated she/he administers the spray for patients and that she/he had received training on hire on how to do this. The surveyor requested to see the standing orders for the anesthetic spray. Review on 2/14/24 at 9:30 AM of the Cryodose spray container, revealed, “Federal USA law restricts this device to sale by, the order of, or use by a licensed healthcare practitioner. Note: This product is a medical device and not a drug. During an interview on 2/14/24 at 9:45 AM, the Clinic Manager verified Patient Care Technicians are not licensed health care practitioners. The Clinic Manager stated she/he had reviewed the physician orders and there were no standing orders or other orders for patients to get the anesthetic spray. Review of Patient #6’s medical record as well as Patient #1, #2, and #3 on 2/14/24 revealed no physician orders for the Cryodose anesthetic spray.”