Dci Chattanooga 3rd St

“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: 40606 Based on review of the facility policy, medical record review, observation and interview, the facility failed to ensure staff followed infection control measures prior to access of a fistula (surgical connection between an artery and vein created for hemodialysis treatment) for 1 Patient (#7) of 4 patients observed for vascular access cannulation (insertion of needles for dialysis treatment). The findings include: Review of the facility policy titled, “Cannulation of Arteriovenous Fistula (AVF) with safety needles” undated, showed “...Purpose...Provide guidelines for successful cannulation...and to prevent infection...Cannulation sites must not be touched after skin disinfection has been completed. If sites are touched by staff or patient after disinfection has occurred, sites must be disinfected again...” Medical record review revealed Patient #7 was admitted to the facility on 11/20/2023 with diagnoses including End Stage Renal Disease. During an observation on 8/5/2024 at 11:28 AM, Certified Clinical Hemodialysis Technician (CCHT) G at Station 2 prepared Patient #7 for initiation of dialysis. CCHT G disinfected the first vascular access site with an alcohol prep pad, allowed to dry and inserted the needle. CCHT G disinfected the 2nd vascular access site with an alcohol prep pad, allowed to dry, then palpated the previously disinfected site with their left hand. CCHT G then cannulated the 2nd site without disinfecting the site again after the palpation of the site. During an interview on 8/7/2024 at 10:35 AM, the Clinical Manager (CMA) confirmed staff are to follow the facility policy and re-disinfect the vascular access site prior to inserting dialysis needles after palpation.”

“ENVIRONMENT-SECURE & RESTRICTED CFR(s): 494.40(a) 8 Environment: secure & restricted The water purification and storage system should be located in a secure area that is readily accessible to authorized users. The location should be chosen with a view to minimizing the length and complexity of the distribution system. Access to the purification system should be restricted to those individuals responsible for monitoring and maintenance of the system. This Standard is not met as evidenced by: 40606 Based on observations and interviews, the facility failed to ensure safety controls were in place to prevent or restrict unauthorized entrance into the area where the acid concentrate (fluid used in dialysis treatments) storage tanks were located inside the facility. The findings include: During an observation on 8/6/2024 at 10:20 AM, a widened, framed doorway, which was approximately 5 feet from the dialysis treatment area, was without identification signage or a control mechanism that would prevent unauthorized entry into the area. Further observation revealed the area housed 4 back up dialysis machines, various supplies, and a second framed doorway which was passed through to reveal 2 large, partially full acid concentrate storage tanks with distribution system, an acid concentrate mixer with reservoir, and 2 partial pallets of dry-mix acid concentrate. Also noted in the area was various pieces of equipment used to test the acid after mixing and items used to repair the facility’s dialysis machines. There was nothing to impede access from the dialysis floor to the area which housed the acid and delivery system. During an interview on 8/7/2024 at 11:00 AM, the Bio-Med Manager stated the doorway was widened to allow the pallets to pass through when the dry-mix acid delivery arrived. The Bio-Med Manager stated he was unaware the area which housed the backup machines, testing equipment, supplies, and the facility’s acid distribution system needed a safety control to prevent access of unauthorized individuals. During an interview on 8/7/2024 at 12:10 PM, the Area Operations Director (AOD) stated he was unaware the area that housed the facility’s backup machines, testing equipment, supplies, and the facility’s acid mixing and distribution system needed a safety control to prevent access of unauthorized individuals. When the question was posed to the AOD of “How was the area secure?” No answer was verbalized.”

“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: 27405 Based on facility policy review, medical record review, observation and interview, the facility failed to meet the prescribed target weight for 1 patient (Patient #1) of 5 patients reviewed for the delivery of hemodialysis (HD) treatments. The findings include: Review of the facility policy titled, “Calculating Fluid Removal,” dated 9/26/2018, revealed “...Dry weight may be also referred to as ideal body weight (IDW) target weight, or estimated dry weight (EDW)...The plan of care must address dose of dialysis. The interdisciplinary team must provide the necessary care and services to manage the patient’s volume status...evidence of implementation of the plan of care for this aspect would include treatment records reflecting attaining the target weight...or documentation acknowledging the target weight was not attained with an assessment of the reason for not attaining it, and a plan to correct this issue...” Medical record review revealed Patient #1 was admitted to the facility for incenter hemodialysis on 4/2/2021, with diagnoses including End Stage Renal Disease. Review of a Practitioner Encounter Note for Patient #1, dated 6/7/2024, revealed “...continue with large gains...education ongoing...” Continued review revealed “change in plan of care” not marked. Review of Patient #1’s hemodialysis (HD) treatment flow sheets for 7/17/2024 and 7/19/2024, revealed the patient’s prescribed target weight was 127.5 kg (kilograms). Further review revealed Patient #1’s post dialysis weights were over the prescribed target weight. Review of the 2 treatment flowsheets revealed: 7/17/2024 - Pre Weight 135.2 kg, Post Weight 131.0 kg (3.5 kg or 7.7 pounds above the prescribed target weight). 7/19/2024 - Pre Weight 133.7 kg, Post Weight 130.0 kg (2.5 kg or 5.5 pounds above the prescribed target weight). Review of Patient #1’s HD treatment flowsheet for 7/22/2024 revealed the patient’s prescribed target weight was increased to 128.5 kg. Patient #1’s Pre Weight was 135.4 kg, Post Weight was 131.2 kg (2.7 kg or 5.9 pounds above the prescribed target weight). Review of Patient #1’s HD treatment flow sheets for 7/24/2024 through current revealed the patient’s target weight was increased to 130 kg. Review of the Interdisciplinary Care Plan completed 2/29/2024, revealed the care plan was not updated to include the problem of chronic fluid overload and did not address the need for effective interventions to assist the patient in meeting the prescribed target weight. During an observation on 8/5/2024 at 11:05 AM, Patient #1 was dialyzing with a blood flow rate (BFR) of 400 with a goal to remove 5400 ml (milliliter) in the prescribed 4 hour treatment. Continued observation revealed resident tolerating dialysis with no concerns noted. During an interview, with review of HD treatment flow sheets, on 8/7/2024 at 11:38 AM, the Clinic Manager confirmed Patient #1’s post dialysis weights were above the prescribed target weight on the dates reviewed and the Interdisciplinary Care Plan had not been updated with interventions to address the Patient #1’s fluid volume status.”