Fmc Eastern Tennessee

“PA-DIALYSIS ACCESS TYPE & MAINTENANCE CFR(s): 494.80(a)(8) The patient’s comprehensive assessment must include, but is not limited to, the following: (8) Evaluation of dialysis access type and maintenance (for example, arteriovenous fistulas, arteriovenous grafts and peritoneal catheters). This Standard is not met as evidenced by: 51389 Based on facility policy review, observation and interview, the facility failed to follow safety procedures to check for a thrill (pulsation) on a hemodialysis access in 1 out of 1 patient (Patient #1) observed with a clamp used to stop bleeding at the end of a dialysis treatment. The findings include: Review of facility policy, “Venipuncture Site Clamps,” dated 5/5/2025, revealed “...keep clamp use to a minimum. Patient...should be instructed to hold sites via direct pressure whenever possible...spring loaded clamps are the only clamps that can be used but can only be used in accordance with this policy and procedure...while the clamp remains on the access, check for thrill every 10 minutes...patient care staff must monitor clamp placement carefully while in use as clamp may slip and result in blood loss...check the access for the presence of a thrill. If a thrill is not present adjust clamp until you feel a continuous thrill...” Medical record review revealed Patient #1 was admitted to the facility on 4/15/2024, with ESRD (End Stage Renal Disease), Diabetes and Hypertension. Observation of Patient #1, during termination of the dialysis treatment on 12/8/2025 at 12:14 PM, revealed RN (Registered Nurse) A removed the first dialysis access needle, applied the clamp and then exited the station. RN A failed to assess Patient #1’s access for a thrill. Continued observation revealed the RN failed to monitor Patient #1 after 10 minutes of the clamp being in place. PCT (Patient Care Technician) A removed the clamp at 12:34 PM, and checked for a thrill after she removed it. During an interview on 12/9/2025 at 1:15 PM, with the Facility Manager verified if clamps are used on a patient’s dialysis access, the staff must check the patient’s access for a thrill after the clamp is placed, and then every 10 minutes while the clamp is in place. During an interview on 12/11/2025 at 5:00 PM, with RN A revealed she did remove Patient #1’s dialysis needles and used a clamp to stop the bleeding. She stated she thinks the clamps are to be left on for 10 minutes and they should be checked every 10 minutes.”

“POC-COMPLETED/SIGNED BY IDT & PT CFR(s): 494.90(b)(1) The patient’s plan of care must- (i) Be completed by the interdisciplinary team, including the patient if the patient desires; and (ii) Be signed by the team members, including the patient or the patient’s designee; or, if the patient chooses not to sign the plan of care, this choice must be documented on the plan of care, along with the reason the signature was not provided. This Standard is not met as evidenced by: 27405 Based on facility policy review, medical record review and interview, the facility failed to ensure patient involvement in the Plan of Care (POC) for 4 of 4 patients (Patient #1, Patient #2, Patient #3, and Patient #4) of the 5 sampled incenter hemodialysis patients. The findings include: Review of the facility’s policy, “Comprehensive Interdisciplinary Assessment and Plan of Care,” dated 7/3/2023, revealed “...The patient’s level of participation is determined by the patient. The patient must sign the plan of care meant to acknowledge the information in the plan. If the patient chooses not to sign their plan of care, the reason for refusal must be documented in the patient’s medical record...” Medical record review revealed Patient #1 was admitted to the facility on 4/15/2024 with diagnoses including End Stage Renal Disease and Diabetes Mellitus. Review of Patient #1’s POC revealed the last Interdisciplinary Team (IDT) meeting was dated 9/22/2025, with the absence of the patient’s signature, indicating the POC was reviewed without participation by Patient #1. Continued review revealed no documentation of a reason why the patient’s signature was absent. Medical record review revealed Patient #2 was admitted to the facility on 11/12/2022, with diagnoses including End Stage Renal Disease, Fournier’s Gangrene and Diabetes Mellitus. Review of Patient #2’s POC revealed the last Interdisciplinary Team (IDT) meeting dated 9/22/2025, with the absence of the patient’s signature, indicating the POC was reviewed without participation by Patient #2. Continued review revealed no documentation of a reason why the patient’s signature was absent. Medical record review revealed Patient #3 was admitted to the facility on 4/18/2025, with diagnoses including Chronic Kidney Disease and Diabetes Mellitus. Review of Patient #3’s POC revealed the last Interdisciplinary Team (IDT) meeting dated 9/22/2025, with the absence of the patient’s signature, indicating the POC was reviewed without participation by Patient #3. Continued review revealed no documentation of a reason why the patient’s signature was absent. Medical record review revealed Patient #4 was admitted to the facility on 3/03/2022, with diagnoses including Chronic Kidney Disease and Diabetes Mellitus. Review of Patient #4’s POC revealed the last Interdisciplinary Team (IDT) meeting was dated 9/22/2025, with the absence of the patient’s signature, indicating the POC was reviewed without participation by Patient #4. Continued review revealed no documentation of a reason why the patient’s signature was absent. During an interview and concurrent review of the POC’s for Patient #1, Patient #2, Patient #3, and Patient #4 on 12/9/2025 at 12:30 PM, the Dialysis Center Manager confirmed the center’s policy for Comprehensive Plan of Care was not followed.”