Fmc Memphis

“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: 19001 Based on policy review, observation and interview, the facility failed to ensure staff performed proper hand hygiene for 1 of 4 (PCT #1) PCTs observed. The findings included: 1. Review of the facility policy published 11/6/2023 “Hand Hygiene” revealed, “...All staff...must follow the same requirements for hand hygiene. Hand hygiene included either washing hands with soap and water or using alcohol-based antiseptic hand rub with 60%-90% alcohol content...Hands will be...decontaminated using alcohol- based hand rub or by washing hands with antimicrobial soap and water...After contact with inanimate objects near the patient...After contact with other objects within the patient station or treatment space...” 2. Observations on 8/19/2024 at 10:45 AM revealed PCT #1 touched the lip of a black rolling trashcan, with clean gloved hands and pulled it toward her. PCT #1 then opened a clean dialyzer and blood lines to set up the machine at station #1. 3. During an interview on 8/20/2024 at 2:00 PM, the CM verified staff should perform hand hygiene after touching a garbage can.”

“IC-DISINFECT SURFACES/EQUIP/WRITTEN PROTOCOL CFR(s): 494.30(a)(4)(ii) [The facility must demonstrate that it follows standard infection control precautions by implementing- (4) And maintaining procedures, in accordance with applicable State and local laws and accepted public health procedures, for the-] (ii) Cleaning and disinfection of contaminated surfaces, medical devices, and equipment. This Standard is not met as evidenced by: 19001 Based on policy review, observation and interview, the facility failed to ensure 2 of 3 (PCT #2 and PCT #3) PCTs appropriately cleaned dialysis equipment between patients. The findings included: 1. Review of the facility policy published 9/5/2023 revealed, “Purpose: The purpose of this policy is to provide guidelines to prevent the spread of infectious disease...and to maintain a clean, safe, and aesthetically pleasant environment...” The Centers for Medicare and Medicaid (CMS) has regulations that in order to prevent cross contamination, a dialysis station must be cleaned and disinfected between dialysis patients. The chair and dialysis equipment are used by multiple patients during a treatment day and it is critical that these items be thoroughly cleaned and disinfected...Definition Dialysis Station- Area including the dialysis machine, chair/bed and other reusable equipment...Externally disinfect the dialysis machine with 1:100 bleach solutions after each dialysis treatment...” 2. Observations on 8/19/2024 at 9:50 AM revealed PCT #3 removed the prime waste container at station # 11, emptied the waste into the dirty sink and rinsed the container with tap water. The container was not cleaned with bleach solution. Observation on 8/19/2024 at 10:51 AM revealed PCT #2 removed the prime waste container at station #15, emptied the waste into the dirty sink and rinsed the container with tap water. The container was not cleaned with bleach solution. 3. During an interview on 8/19/2024 at 3:08 PM, the CM verified the staff should remove the prime container, pour the contents into the dirty sink, and clean the container with bleach solution as a part of cleaning the dialysis machine.”

“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: 19001 Based on policy review, medical record review and interview, the facility failed to implement measures to address hypertensive episodes for 1 of 7 (Patient #7) sampled patients. The findings included: 1. Review of the facility policy titled “Hypertension” dated 9/7/2021 revealed, “ ...Notify the nurse in charge if a patient has a systolic blood Review of the facility policy titled, “Hypertension” dated 9/7/2021 revealed, “ ...1. pressure greater than 180 mm/Hg and/or diastolic blood pressure greater than 100 mm/Hg ...2. The RN will assess the patient and determine if further nursing interventions are needed ...5. Document in patient’s treatment record ...” 2. Medical record review for Patient #7 revealed an admission date of 4/10/2023 with diagnoses which included Hypertensive Chronic Kidney Disease and End Stage Renal Disease. Review of Patient #7’s “Admission/Standing Orders” revised 1/2/2024 revealed, “ ...Blood Pressure...1. admission blood pressure is greater than 180/100 wait one hour before medicating patient...After one hour of treatment if patient’s blood pressure is still greater than 180/100 follow intradialytic dosing of B/P...2. Admission blood pressure is equal to or greater than 220/110 and does not decrease to 180/100 by the first 30 minutes of treatment administer Clonidine 0.2 mg and then continue to follow intradialytic dosing of B/P...Intradialytic: After one hour of treatment give Clonidine 0.2 mg for systolic B/P greater than 180 or diastolic greater than 100. Check B/P in one hour, if systolic still greater than 180 or diastolic greater than 100, repeat Clonidine 0.2 mgs. Check B/P in one hour after second dose of Clonidine, if no improvement, notify MD ...Post Treatment...Clonidine 0.1 mg for systolic B/P 160-180 or diastolic greater than 100. After one hour if systolic is still 160-180 or diastolic greater than 100, give Clonidine 0.1 mg. If still no improvement in one hour after second dose of Clonidine, notify M.D...” Review of the physician’s orders dated 6/26/2024 revealed the Patient’s blood pressure should be treated with Clonidine, a medication to treat high blood pressure, 0.1 mg should be given by mouth as needed and may be repeated once. Review of the physician’s orders dated 7/19/2024, 8/5/2024, and 8/16/2024 revealed the Patient was to receive in-center hemodialysis treatments 3 times a week via a CVC. Review of the Treatment Sheet dated 8/2/2024 revealed a pre-treatment blood pressure of 190/108 at 7:15 AM. The treatment was initiated at 7:13 AM and ended at 10:28 AM. The Patient’s blood pressures were as follows: 183/103 at 7:13 AM, 190/112 at 7:30 AM, 198/117 at 8:00 AM, 183/106 at 9:00 AM, and 167/103 at 10:28 AM. The post-treatment blood pressure was 171/105 at 10:38 AM. Facility staff failed to address Patient #7’s blood pressure and did not administer supplemental Clonidine 0.1 mg, which was prescribed by the physician. Review of the Treatment Sheet dated 8/5/2024 revealed a pre-treatment blood pressure of 189/103 at 7:11 AM. The treatment was initiated at 7:10 AM and ended at 10:40 AM. The Patient’s blood pressures were as follows: 178/104 at 7:40 AM, and 171/102 at 8:10 AM. The post-treatment blood pressure was 182/105 at 10:43 AM. Facility staff failed to address Patient #7’s blood pressure and did not administer supplemental Clonidine 0.1 mg, which was prescribed by the physician. Review of the Treatment Sheet dated 8/17/2024 revealed a pre-treatment blood pressure of 200/109 at 10:22 AM. The treatment was initiated at 10:20 AM and ended at 12:20 PM. The Patient’s blood pressures were as follows: 191/114 at 10:50 AM, 185/116 at 11:09 AM, 195/122 at 11:20 AM, 178/121 at 12:20 PM. The post-treatment blood pressure was 222/128 at 12:22 PM. Facility staff failed to address Patient #7’s blood pressure and did not administer supplemental Clonidine 0.1 mg, which was prescribed by the physician. 3. During an interview on 8/20/2024 at 9:20 AM, the CM stated “...the elevated blood pressure should be reported to the Charge Nurse, who should assess the patient...the Charge Nurse should follow the standing orders for the patient, give Clonidine and notify the MD...all interventions should be documented on the flowsheet...””

“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: 33487 Based on policy review, medical record review and interview, the facility failed to ensure physician’s orders for prescribed BFR and/or DFR were followed for 4 of 7 (Patient #2, #3, #6, and #7) sampled patients who received hemodialysis. The findings included: 1. Review of the facility policy titled, “Patient Monitoring and Safety Checks During Hemodialysis Treatment” dated 9/5/2023 revealed, “...The purpose of this document is to provide guidance for patient monitoring and safety check guidelines during the hemodialysis treatments...Verify dialysate lines are attached and in correct position and DFR, BFR, and UFR is set and functioning per treating physician order...” Review of the facility’s “Auto Flow Dialysate,” policy dated 4/5/2021, revealed “...The purpose of this policy is to provide guidance on the use of the auto flow dialysate...Depending on the auto flow rate selected the dialysate flow rate will be either 1.5 or 2.0 times the blood flow rate. The dialysate flow rate will change when the user changes the blood flow rate...” 2. Medical record review for Patient #2 revealed an admission date of 12/5/2000 with diagnoses of End Stage Renal Disease. Review of the Physician Order for Patient #2 dated 5/22/2024, revealed “..BFR 400, DFR 800 ml/min...” Review of the Treatment Sheet for Patient #2 dated 7/22/2024 revealed the BFR was 350 instead of 400 as prescribed at the following times: 6:55 AM, 7:30 AM, 8:00 AM, 8:30 AM, 9:00 AM, 9:30 AM, 10:00 AM, and 10:30 AM. There was no documentation why the prescribed BFR was not run at 400 as ordered by the physician. Review of the Treatment Sheet for Patient #2 dated 7/26/2024 revealed the DFR was 600 instead of 800 as prescribed at the following times: 6:54 AM, 7:30 AM, 8:00 AM, 8:30 AM, 9:00 AM, 9:30 AM, and 10:00 AM. There was no documentation why the prescribed DFR was not run at 800 mL/min as ordered by the physician. 3. Medical record review for Patient #3 revealed an admission date of 7/23/2024 with diagnoses of End Stage Renal Disease. Review of the Physician Order for Patient #3 dated 7/23/2024, revealed “ ...BFR 400, DFR: Auto flow 2.0 [800] ...” Review of the Treatment Sheet for Patient #3 dated 7/23/2024, revealed the BFR was 400, and the DFR should have been 800; however Patient #3’s DFR was 600 at the following times: 3:30 PM, 4:00 PM, 4:30 PM, and 5:00 PM. There was no documentation why the prescribed DFR was not run at Auto flow 2.0/800 mL/min as ordered by the physician. Review of the Treatment Sheet for Patient #3 dated 7/25/2024, revealed the BFR was 400, and the DFR should have been 800; however Patient #3’s DFR was 600 at 8:30 AM. There was no documentation why the prescribed DFR was not run at 800 mL/min as ordered by the physician. Review of the Treatment Sheet for Patient #3 dated 7/27/2024, revealed the BFR was 300, instead of the 400 as prescribed at the following times: 7:26 AM, 7:30 AM, 8:00 AM, 9:00 AM, 9:30 AM, 10:00 AM, and 10:30 AM. 4. Medical record review for Patient #6 revealed an admission date of 11/3/2020 with diagnoses of Hypertensive Chronic Kidney Disease and End Stage Renal Disease. Review of the Physician Order for Patient #6 dated 6/24/2024, revealed “..BFR 400, DFR Autoflow 1.5...” Review of the Treatment Record for Patient #6 dated 8/2/2024 revealed the BFR was 350 instead of 400 as prescribed at the following times: 7:30 AM, and 8:00 AM. There was no documentation why the prescribed BFR was run at 350 instead of 400 as prescribed. 5. Medical record review for Patient #7 revealed an admission date of 4/10/2023 with diagnoses of Hypertensive Chronic Kidney Disease and End Stage Renal Disease. Review of the Physician Order dated 7/19/2024, revealed “...BFR 350, DFR Manual 700 mL/min...” Review of the Treatment Record for Patient #7 dated 7/31/2024 revealed the DFR was 800 mL/min instead of Manual 700 mL/min as prescribed at the following times: 7:07 AM, 7:30 AM, and 8:00 AM. There was no documentation why the prescribed DFR was not run at Manual 700 mL/min as ordered by the physician. Review of the Physician Order for Patient #7 dated 8/5/2024, revealed “...BFR 250, DFR Manual 600 mL/min...” Review of the Treatment Record dated 8/5/2024 revealed the DFR was 800 mL/min instead of Manual 600 mL/min as prescribed at the following times: 9:00 AM, 9:30 AM, and 10:00 AM. There was no documentation why the prescribed DFR was not run at Manual 600 mL/min as ordered by the physician. 6. During an interview on 8/20/2024 at 8:50 AM, the CM confirmed there should have been documentation stating why the BFR’s and DFR’s were not run as ordered and staff was not following physician orders. During an interview on 8/20/2024 at 9:20 AM, the CM stated “...the BFR/DFR should be reported to the Charge Nurse, who should assess why it is not running according to the physician’s order and contact if necessary...staff should document why adjustments were made during treatment...””