Dci Dayton

“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: 27405 Based on facility policy review, observation and interview, the facility failed to ensure nursing staff followed facility procedure for the administration of an oral medication. The findings include: Review of the facility policy, “MEDICATION POLICY,” dated 5/22/2013, revealed “...Preparation and Administration of Medication...Nurses are responsible for administering medications throughout the time they are scheduled to go off duty to ensure all medications are properly administered...” Review of the facility policy, “Administration of Rocaltrol [viamin D preperation],” dated 1/17/2019, revealed “...POLICY...All licensed personnel administering...will have a skills checklist reflecting mastery of medication administration...PROCEDURE...Verify physician’s order...Perform hand hygiene, don PPE (personal protective equipment) ...Administer...per 5 rights of medication administration...Remove gloves (PPE), perform hand hygiene...” Review of Registered Nurse (RN A’s) Medication Administration Skills Checklist, signed 6/20/2025, revealed “...Medication Administration...Medication (Basic) Knowledge...Medication is prepared in clean dedicated area; Discards med if placed on a contaminated surface,,,Hand hygiene prior to medication preparation...Meds (PO) [by mouth] are not handled with bare hands...discards gloves and hand hygiene...” Observations of the clinical area on 9/15/2025, from 1:45 PM to 2:05 PM, revealed RN A was present at the medication counter at the nurses’ station preparing medications. At 1:50 PM, RN A obtained a bottle of medication from the locking medication storage cabinet below the medication counter. RN A opened a bottle of medication and dropped 3 tablets into a medication cup, a 4th tablet exited the bottle, bounced off of the tablets in the medication cup, and rolled across the medication counter. RN A observed the tablet roll across the counter, picked up the tablet with her non gloved right hand and placed the tablet into the medication bottle. RN A placed the medication bottle with the contaminated tablet back into the medication storage cabinet for the next use...” During an interview with observation on 9/15/2025 at 1:55 PM, RN A confirmed she placed a tablet back in its original container after a tablet had rolled across the medication counter during medication preparation. She stated “...I probably shouldn’t have...” when questioned regarding the preparation and storage of medications. RN A then opened the medication storage cabinet, the bottle of medication which contained the contaminated tablet was present and available for use. During an interview on 9/17/2025 at 10:20 AM, the Area Operations Director stated the facility did not have a policy for the medication RN A had prepared and subsequently allowed a tablet to roll across the counter. A policy/procedure was used for reference of another medication which was a medication given PO (by mouth). The Area Operation Assistant stated the procedure is basically the same and confirmed RN A did not follow the facility’s medication preparation procedure.”

“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 and interview, the facility failed to address 1 patient’s (Patient #6) fluid volume status within the plan of care of 6 patients reviewed for fluid and blood pressure management. The findings include: Review of the facility policy, “Patient Assessment And Patient Plan of Care,” revised 3/2022, showed “...PURPOSE...To establish an individualized, comprehensive plan of care that addresses the patient’s needs...Assessment criteria...The patient’s comprehensive assessment must include at a minimum...Evaluation of the appropriateness of the dialysis prescription, blood pressure, and fluid management needs...The plan of care must...specify services necessary to address the patient’s needs...include measurable and expected outcomes...” Review of the facility policy, “Post-Treatment Assessment,” dated 9/26/2018, showed “...Routine post treatment assessment will include but not limited to...Respiratory status...Cardiac status...Dry weight...Assessment of vital signs...Any vital sign or assessment...abnormality will be reported to Physician...” Patient #6 was admitted to the facility on 2/7/2025 with diagnoses including Anemia and End Stage Renal Disease. Review of Patient #6’s Hemodialysis Treatment Sheets dated 8/25/2025-9/12/2025, showed the prescribed estimated dry weight (EDW) was 153.0 kilograms/kgs (1 kg = 2.2 pounds). Review showed Patient #6’s post-dialysis weights were 1.2 to 3 (6.6 pounds) greater than the physician prescribed EDW for 6 of 9 treatments reviewed. Patient #6’s fluid status at the end of treatments, determined by the post dialysis weight, showed the interdialytic (between treatments) weight gain was not completely removed. Continued review showed Patient #6’s pre-dialysis weight on 9/1/2025 was 161.0 kgs, which was 8 kg (17.6 pounds) over the EDW. The nursing staff noted on multiple dialysis flowsheets of either excessive weight gains or Patient #6 leaving the clinic with greater than desired fluid weight (heavy). Further review revealed no documentation of Patient #6’s fluid status was communicated to the physician or Nurse Practitioner (NP) for each day Patient #6 left the clinic heavy. There were no entries on the treatment sheets of interventions for excess fluid gains being addressed by the patient’s interdisciplinary team (IDT). Review of Patient #6’s care plan dated 3/18/2025, showed no documentation of interventions developed by the IDT team to address Patient #6’s excessive fluid gains between dialysis treatments. No documentation of any avenues explored by the IDT team to address Patient #6’s excessive fluid gains and return to the prescribed EDW was added to the care plan. During an interview on 9/16/2025 at 10:55 AM, the NP stated when excessive fluid gains were recognized, interventions such as UF (ultra filtration-removal of fluid) profiling (a program within the dialysis machine) to aid in obtaining fluid from patients by utilizing UF for 1 hour at the beginning of treatment. No UF or other interventions were documented on Patient #6’s care plan to address excess fluid gains. During an interview on 9/17/2025 at 9:08 AM, the Charge Nurse (CN B) confirmed he was aware Patient #6 had excessive fluid gains between dialysis treatments. CN B confirmed Patient #6’s care plan did not identify and implement actions to aid in improvement of Patient #6’s fluid management. CN B confirmed Patient #6 had ongoing problems with excessive fluid intake during and between dialysis treatments and Patient #6’s care plan did not indicate Patient #6 had a fluid volume problem.”