Davita Clarksville Dialysis

“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: 33763 Based on policy review, medical record review and interview, the facility failed to ensure physician’s orders for prescribed BFR were followed for 4 of 7 (Patient #1, #4, #5, and #7) sampled hemodialysis patients. The findings included: 1. Review of the facility policy titled, “Pre-Intra-Post Treatment Data Collection, Monitoring and Nursing Assessment” revised April 2024 revealed, “...Purpose: To obtain and document baseline and ongoing information about the patient before, during and after the dialysis treatment through data collection and nursing assessment. This information will be used in planning and documenting the patient’s dialysis treatment, monitoring during treatment and for reviewing the patient’s response to the treatment and status prior to discharge...Patient identity, prescription and machine settings are verified by teammate prior to initiation of treatment with the exception of blood flow rate which is verified and documented when the ordered rate is obtained after onset of treatment...Intradialytic Data Collection/Assessment...If the dialysis prescription is not being met (including dialysis flow rate or change to/inability to obtain prescribed blood flow rate) the reason will be documented and the licensed nurse informed...” 2. Medical record review for Patient #1 revealed an admission date of 4/11/2017 with diagnoses which inluded End Stage Renal Disease. Review of the physician’s orders dated 11/22/2024 and 12/14/2024 revealed a BFR of 450 ml/min. Review of the Treatment Details Report dated 11/22/2024, revealed the BFR was 400 ml/min instead of 450 ml/min as prescribed from 10:30 AM until 1:54 PM. There was no documentation why the prescribed BFR was not followed. Review of the Treatment Details Report dated 11/24/2024, revealed the BFR was 400 ml/min instead of 450 ml/min as prescribed from 10:14 AM until 1:39 PM. There was no documentation why the prescribed BFR was not followed. Review of the Treatment Details Report dated 12/2/2024, revealed the BFR was 400 ml/min instead of 450 ml/min as prescribed from 11:11 AM until 1:39 PM. There was no documentation why the prescribed BFR was not followed. Review of the Treatment Details Report dated 12/9/2024, revealed the BFR was 400 ml/min instead of 450 ml/min as prescribed from 10:05 AM until 1:35 PM. There was no documentation why the prescribed BFR was not followed. 3. Medical record review for Patient #4 revealed an admission date of 3/11/2024 with diagnoses which included End Stage Renal Disease. Review of the physician’s orders dated 10/7/2024 and 11/22/2024 revealed a BFR of 400 ml/min. Review of the Treatment Details Report dated 11/20/2024, revealed the BFR was 300 ml/min instead of 400 ml/min as prescribed from 1:41 PM until 5:10 PM. There was no documentation why the prescribed BFR was not followed. Review of the Treatment Details Report dated 11/29/2024, revealed the BFR was 350 ml/min instead of 400 ml/min as prescribed from 2:32 PM until 4:02 PM. There was no documentation why the prescribed BFR was not followed. 4. Medical record review for Patient #5 revealed an admission date of 9/16/2021 with diagnoses which included Type II Diabetes and End Stage Renal Disease. Review of the physician’s orders dated 10/2/2024, 11/17/2024, 11/25/2024, and 12/14/2024 revealed a BFR of 350 ml/min. Review of the Treatment Details Report dated 10/23/2024, revealed the BFR was 400 ml/min instead of 350 ml/min as prescribed from 2:48 PM until 3:56 PM. There was no documentation why the prescribed BFR was not followed. Review of the Treatment Details Report dated 11/5/2024, revealed the BFR was 400 ml/min instead of 350 ml/min as prescribed from 11:41 AM until 2:38 PM. There was no documentation why the prescribed BFR was not followed. Review of the Treatment Details Report dated 11/12/2024, revealed the BFR was 400 ml/min instead of 350 ml/min as prescribed from 11:14 AM until 2:16 PM. There was no documentation why the prescribed BFR was not followed. Review of the Treatment Details Report dated 11/16/2024, revealed the BFR was 400 ml/min instead of 350 ml/min as prescribed from 11:07 AM until 1:54 PM. There was no documentation why the prescribed BFR was not followed. Review of the Treatment Details Report dated 11/21/2024, revealed the BFR was 400 ml/min instead of 350 ml/min as prescribed from 12:19 PM until 2:50 PM. There was no documentation why the prescribed BFR was not followed. Review of the Treatment Details Report dated 12/3/2024, revealed the BFR was 400 ml/min instead of 350 ml/min as prescribed from 11:28 AM until 2:26 PM. There was no documentation why the prescribed BFR was not followed. Review of the Treatment Details Report dated 12/7/2024, revealed the BFR was 400 ml/min instead of 350 ml/min as prescribed from 10:57 AM until 1:58 PM. There was no documentation why the prescribed BFR was not followed. 5. Medical record review for Patient #7 revealed an admission date of 5/14/2024 with diagnoses which included Type II Diabetes and End Stage Renal Disease. Review of the physician’s orders dated 12/7/2024 revealed a BFR of 400 ml/min. Review of the Treatment Details Report dated 12/9/2024, revealed the BFR was 350 ml/min instead of 400 ml/min as prescribed from 11:11AM until 2:55 PM. There was no documentation why the prescribed BFR was not followed. 6. During an interview on 12/17/2024 at 12:04 PM, the MCS stated staff are expected to follow the physician’s orders for BFRs or document why the prescription wasn’t followed. During an interview on 12/17/2024 beginning at 3:00 PM, the DCS reviewed the Treatment Details Reports for Patient #1, #4, #5, and #7 and verified the prescribed BFR’s were not followed, and staff failed to document the reasons why.”

“MD RESP-ENSURE ALL ADHERE TO P&P CFR(s): 494.150(c)(2)(i) The medical director must- (2) Ensure that- (i) All policies and procedures relative to patient admissions, patient care, infection control, and safety are adhered to by all individuals who treat patients in the facility, including attending physicians and nonphysician providers; This Standard is not met as evidenced by: 33487 Based on policy review, medical record review, and interview, the Medical Director failed to ensure staff followed facility policies when providing care to patients with known allergies for 1 of 7 (Patient #6) patients reviewed. The findings included: 1. Review of the facility policy titled “Central Venous Catheter (CVC) With Clearguard HD Antimicrobial End Caps Procedure,” dated October 2024, revealed “...first choice for CVC care is 2% Chlorhexadine/70% Alcohol swab. If these agents are contraindicated for a patient, the physician will prescribe an agent for the individual...Check the patient sensitivity to preferred skin antiseptic or device disinfectant...refer...for alternate skin antiseptic or device disinfectants...” 2. Medical record review for Patient #6 revealed an admission date of 10/18/2024 with diagnoses which included Acute Kidney Injury and Chronic Kidney Disease, Stage unknown. Review of the Patient Summary Report dated 12/14/2024, revealed “...Allergies...Chlorhexadine...Mild Allergy...Itching, Rash...” Review of the Treatment Details Report dated 11/22/2024, revealed “...Access site prepped using chlorhexadine topical antiseptic...” Review of the Treatment Details Report dated 11/26/2024, revealed “...Access site prepped using chlorhexadine topical antiseptic...” 3. During an interview on 12/17/2024 at 3:10 PM, RN #1 confirmed she had completed Patient #6’s allergy list. During an interview on 12/17/2024 at 2:56 PM, the DCS stated “...If a patient has a medication allergy, it shouldn’t be used...There are alternatives to chlorahexadine...””