Dci Humboldt

“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: 51246 Based on policy review, observations, and interview, the facility failed to ensure hand hygiene was performed in a manner to prevent the spread of potentially infectious bacteria by 2 of 5 (RN #1 and LPN #1) staff observed during 1 of 1 (2/3/2025) observation days on the dialysis treatment floor. The findings included: 1. Review of the facility’s policy “Hand Antisepsis Policy” issued August 2014 revealed “...Handwashing with soap and water must be completed in following situations ...Use of an alcohol based rub may be done in following instances ...Before putting on gloves ...” 2. Observations on the treatment floor on 2/3/2025 beginning at 9:50 AM revealed RN #1 was typing on a computer at the nurse’s station. RN #1 then proceeded to don a pair of gloves and began to clean a random dialysis station. RN #1 completed cleaning the dialysis station, removed gloves and donned a new pair of gloves. RN #1 failed to perform hand hygiene after removing gloves and before donning a new pair of gloves. Continued observations on the treatment floor on 2/3/2025 beginning at 11:15 AM revealed LPN #1 picked a glove up off the floor and threw it away in a trash can. LPN #1 then proceeded to don a pair of gloves without first performing hand hygiene. 3. During an interview on 2/5/2025 at 9:05 AM, the NM stated, “Hands should be washed/sanitized between glove changes.””

“IC-STAFF EDUCATION-CATHETERS/CATHETER CARE CFR(s): 494.30(a)(2) Recommendations for Placement of Intravascular Catheters in Adults and Children I. Health care worker education and training A. Educate health-care workers regarding the ... appropriate infection control measures to prevent intravascular catheter-related infections. B. Assess knowledge of and adherence to guidelines periodically for all persons who manage intravascular catheters. II. Surveillance A. Monitor the catheter sites visually of individual patients. If patients have tenderness at the insertion site, fever without obvious source, or other manifestations suggesting local or BSI [blood stream infection], the dressing should be removed to allow thorough examination of the site. Central Venous Catheters, Including PICCs, Hemodialysis, and Pulmonary Artery Catheters in Adult and Pediatric Patients. VI. Catheter and catheter-site care B. Antibiotic lock solutions: Do not routinely use antibiotic lock solutions to prevent CRBSI [catheter related blood stream infections]. This Standard is not met as evidenced by: 51246 Based on facility policy review, observation, and interview the facility failed to ensure CVC port connections were scrubbed according to policy for 1 of 2 (RN #2) staff observed performing CVC care and a clean field was not placed under CVC ports according to policy. The findings included: 1. Review of the facility policy “CVC: Accessing with closed system connectors” issued 10/2018, revealed, “...Scrub port connections (Arterial and Venous) with alcohol prep pad: cleanse a minimum of 15 seconds... Place barrier pad underneath CVC lumens ...” 2. Observations on 2/3/2025 at 11:23 AM revealed RP #1 received CVC Exit Site Care by RN #2 at Station #5. RN #2 did not scrub the arterial or venous port connections prior to placing new caps, the minimum of 15 seconds as per facility policy. Observations on 2/3/2025 at 11:25 AM revealed RP #2 received CVC Exit Site Care by RN #2 at Station #6. RN #2 did not place a clean barrier pad underneath the CVC lumens as per facility policy. 3. During an interview on 2/5/2025 at 9:08 AM with the NM, she stated staff should scrub the connections the required 15 seconds as per policy and could view a clock’s second hand to verify the required 15 seconds. The NM also verified a clean barrier pad should be usedunderneath the CVC lumens.”

“POC-ACHIEVE ADEQUATE CLEARANCE CFR(s): 494.90(a)(1) Achieve and sustain the prescribed dose of dialysis to meet a hemodialysis Kt/V of at least 1.2 and a peritoneal dialysis weekly Kt/V of at least 1.7 or meet an alternative equivalent professionally-accepted clinical practice standard for adequacy of dialysis. This Standard is not met as evidenced by: 51246 Based on policy review, medical record review and interview, the facility failed to ensure 4 of 7 (Patient #3, 5, 6 and 7) sampled patients received the prescribed dialysis prescription for BFR and/or Heparin. The facility also failed to notify the physician of changes to the dialysis prescriptions. The findings included: 1. Review of the facility policy “Initiation of Hemodialysis Treatment for AVF/AVG and CVC” revised 11/10/2016, revealed, “...Adjust blood flow rate according to access/physician orders... Document BFR obtained and efforts/resolution ... Sets treatment parameters (dialysis prescription)... Hourly Heparin dosage ...” 2. Medical record review for Patient #3 revealed an admission date of 10/15/2023 with diagnoses that included ESRD and secondary hypertension. Review of an 10/21/2023 physician’s order that was renewed 9/23/2024 revealed BFR of 400. Review of the 1/31/2025 Hemodialysis Flowsheet revealed the BFR was 200 from 7:01 AM until 7:30 AM, 250 from 7:31 AM until 8:00 AM, and 200 from 8:01 AM until 10:31 AM. There was no documentation stating why the BFR was not delivered at the ordered rate of 400. There was no documentation of the physician being notified. Review of the 1/29/2025 Hemodialysis Flowsheet revealed the BFR was 200 from 7:03 AM until 7:32 AM. There was no documentation stating why the BFR was not delivered at the ordered rate of 400. There was no documentation of the physician being notified. Review of the 1/24/2025 Hemodialysis Flowsheet revealed the BFR was 350 from 7:03 AM until 9:32 AM, 300 from 9:33 AM until 10:32 AM, and 250 from 10:33 until 10:43. There was no documentation stating why the BFR was not delivered at the ordered rate of 400. There was no documentation of the physician being notified. Review of the 1/17/2025 Hemodialysis Flowsheet revealed the BFR was 300 from 7:00 AM until 7:29 AM, and 250 from 7:3o AM until 10:30 AM. There was no documentation stating why the BFR was not delivered at the ordered rate of 400. There was no documentation of the physician being notified. Review of the 1/1/2025 Hemodialysis Flowsheet revealed the BFR was 300 from 7:02 AM until 8:01 AM, and 350 from 8:02 AM until 11:02 AM. There was no documentation stating why the BFR was not delivered at the ordered rate of 400. There was no documentation of the physician being notified. Review of the 12/24/2024 Hemodialysis Flowsheet revealed the BFR was 200 from 8:01 AM until 12:06 PM. There was no documentation stating why the BFR was not delivered at the ordered rate of 400. There was no documentation of the physician being notified. Review of the 1/1/2025 Hemodialysis Flowsheet revealed the BFR was 300 from 7:02 AM until 8:01 AM, and 350 from 8:02 AM until 11:02 AM. There was no documentation stating why the BFR was not delivered at the ordered rate of 400. There was no documentation of the physician being notified. 3. Medical record review for Patient #5 revealed an admission date of 12/5/2024 with diagnoses that included Acute Tubulo-Interstitial Nephritis. Review of a 12/1/2024 physician’s order revealed BFR of 350. Review of the 1/8/2025 Hemodialysis Flowsheet revealed the BFR was 300 from 10:01 AM until 1:01 PM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/13/2025 Hemodialysis Flowsheet revealed the BFR was 200 from 1:30 PM until 4:31 PM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/17/2025 Hemodialysis Flowsheet revealed the BFR was 400 from 7:03 AM until 9:33 AM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/20/2025 Hemodialysis Flowsheet revealed the BFR was 400 from 7:33 AM until 11:08 AM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/22/2025 Hemodialysis Flowsheet revealed the BFR was 400 from 7:03 AM until 11:03 AM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/24/2025 Hemodialysis Flowsheet revealed the BFR was 400 from 6:09 AM until 10:08 AM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/27/2025 Hemodialysis Flowsheet revealed the BFR was 400 from 6:59 AM until 11:03 AM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. 4. Medical record review for Patient #6 revealed an admission date of 11/16/2024 with diagnoses that included ESRD and Secondary Hypertension. Review of an 9/2/2024 physician’s order revealed a Heparin load of 8000 units with 1000 units hourly times 3 hours. Review of the 2/1/2025 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 1000 units was not charted as given. There was no documentation stating why the hourly dose of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 1/25/2025 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 1000 units was not charted as given. There was no documentation stating why the hourly dose of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 1/18/2025 Hemodialysis Flowsheet revealed the 8000 unit load of Heparin was not given nor was the hourly dose of IV Heparin 1000 units. There was no documentation stating why the 8000 unit load of Heparin or the hourly dose of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 1/16/2025 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 1000 units was not charted as given. There was no documentation stating why the hourly dose of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 1/14/2025 Hemodialysis Flowsheet revealed the 8000 unit load of Heparin was not given nor was the hourly dose of IV Heparin 1000 units. There was no documentation stating why the 8000 unit load of Heparin or the hourly dose of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 1/9/2025 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 1000 units was not charted as given. There was no documentation stating why the hourly dose of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 1/4/2025 Hemodialysis Flowsheet revealed the 8000 unit load of Heparin was not given nor was the hourly dose of IV Heparin 1000 units. There was no documentation stating why the 8000 unit load of Heparin or the hourly dose of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 1/2/2025 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 1000 units was not charted as given. There was no documentation stating why the hourly dose of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 12/31/2024 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 1000 units was not charted as given. There was no documentation stating why the hourly dose of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 12/26/2025 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 1000 units was not charted as given. There was no documentation stating why the hourly dose of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. 5. Medical record review for Patient #7 revealed an admission date of 11/28/2024 with diagnoses that included Acute Kidney Failure. Review of a 11/27/2024 physician’s order revealed BFR of 350. Review of the 1/31/2025 Hemodialysis Flowsheet revealed the BFR was 300 from 1:37 PM until 4:33 PM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/29/2025 Hemodialysis Flowsheet revealed the BFR was 400 from 11:24 AM at treatment start until 3:25 PM at treatment end. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/27/2025 Hemodialysis Flowsheet revealed the BFR was 405 from 11:40 AM until 3:31 PM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/24/2025 Hemodialysis Flowsheet revealed the BFR was 400 from 12:09 at treatment start until 4:07 PM at treatment end. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/22/2025 Hemodialysis Flowsheet revealed the BFR was 400 from 12:31 PM until 3:31 PM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/20/2025 Hemodialysis Flowsheet revealed the BFR was 200 from 12:11 PM until 12:32 PM, and 400 from 12:33 until 2:37 PM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/17/2025 Hemodialysis Flowsheet revealed the BFR was 400 from 11:49 AM until 3:30 PM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/15/2025 Hemodialysis Flowsheet revealed the BFR was 400 from 11:32 AM until 3:32 PM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/13/2025 Hemodialysis Flowsheet revealed the BFR was 400 from 12:01 PM AM until 3:31 PM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/8/2025 Hemodialysis Flowsheet revealed the BFR was 400 from 10:37 AM until 11:01 AM, and 300 from11:02 AM until 2:32 PM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/6/2025 Hemodialysis Flowsheet revealed the BFR was 400 from 10:39 AM until 2:32 PM. There was no documentation stating why the BFR was not delivered at the ordered rate of 350. There was no documentation of the physician being notified. Review of the 1/2/2025 Hemodialysis Flowsheet revealed the BFR was 300 from 6:30 AM until 9:30 AM. There was no documentation stating why the BFR was not delivered at the ordered rate of 400. There was no documentation of the physician being notified. During an interview on 2/5/2025 at 8:15 AM the NM stated, “Heparin order manually populates and you shouldn’t be able to sign off chart without including it... There should be something noted when changing BFR””