Dci Clarksville Hwy

“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 1 of 2 (Nurse #1) nurses observed performed hand hygiene during the care of dialysis patients. The findings included: 1. Review of the facility policy “STANDARD PRECAUTIONS & INFECTION CONTROL” revised 7/11/2018, revealed, “PURPOSE: To establish guidelines for preventing and controlling the spread of infection in the dialysis setting...Gloves...will be removed, hands washed or gelled, and fresh gloves placed when going from a dirty task to a cleaned task on the same patient...” 2. Observations on 3/18/2024 at 2:10 PM, revealed Nurse #1 terminated the dialysis treatment for RP #1. Nurse #1 used hand gel, donned clean gloves, adjusted the mask on RP #1’s face to cover RP #1’s nose, then opened an alcohol pad to clean the catheter hub. Nurse #1 did not perform hand hygiene and don new gloves between the dirty and clean tasks. Observations on 3/18/2024 at 2:50 PM, revealed Nurse #1 terminated the dialysis treatment for Patient #4. Nurse #1 used hand gel, donned clean gloves, touched the dialysis machine, adjusted the mask on RP #1’s face to cover RP #1’s nose, then retrieved clean supplies from the chairside table. Nurse #1 did not perform hand hygiene and don new gloves between the dirty and clean tasks. 3. In an interview on 3/20/2024 at 10:35 AM, the Clinic Manager verified the nurse should have performed hand hygiene and donned new gloves after adjusting the patient’s facemask.”

“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: 35244 Based on policy review, medical record review, and interview, the facility failed to ensure physician’s orders for prescribed BFR and DFR were followed for 4 of 5 (Patient #1, #3, #4, and #5) sampled patients. The findings included: 1. Review of the facility’s “DOCUMENTATION OF ABNORMAL VALUES & PRESCRIPTION DEVIATIONS DURING TREATMENT” policy (1/31/18) revealed, “...Any deviation from the treatment prescription must also be documented and explained on the flowsheet...Deviations include but are not limited to...not obtaining ordered blood flow rate or dialysate flow rate...” 2. Medical record review for Patient #1 revealed an admission date of 4/26/2021 with diagnoses which included ESRD and Failed Kidney transplant. Review of a 2/12/2024 physician’s order revealed BFR of 350. Review of a 3/7/2023 physician’s order that was renewed on 3/4/2024 revealed DFR of 600. Review of the 2/12/2024 Hemodialysis Flowsheet revealed the DFR was 700 from 11:31 AM until the treatment ended at 2:18 PM. There was no documentation why the DFR was not delivered at the ordered rate of 600. Review of the 2/14/2024 Hemodialysis Flowsheet revealed the DFR was 700 from 12:02 PM until the treatment ended at 3:06 PM. There was no documentation why the DFR was not delivered at the ordered rate of 600. Review of the 2/16/2024 Hemodialysis Flowsheet revealed the BFR was 300 from 12:05 PM AM until 2:02 PM. There was no documentation why the BFR was not delivered at the ordered rate of 350. Review of the 2/23/2024 Hemodialysis Flowsheet revealed the DFR was 700 from 11:32 AM until the treatment ended. There was no documentation why the DFR was not delivered at the ordered rate of 600. 3. Medical record review for Patient #3 revealed an admission date of 9/15/2021 with diagnoses which included Diabetes Mellitus and ESRD. Review of a 11/20/2023 physician’s order revealed BFR of 250. Review of a 7/4/2022 physician’s order revealed DFR of 600. Review of the 1/26/2024 Hemodialysis Flowsheet revealed the BFR was 350 from 11:00 AM until 2:03 PM, then 330 from 2:03 PM until 2:30 PM. There was no documentation why the BFR was not delivered at the ordered rate of 250. Review of the 1/29/2024 Hemodialysis Flowsheet revealed the BFR was 350 from 10:48 AM until 12:22 PM, then 325 from 12:22 PM until 2:04 PM. The BFR was then 350 from 2:04 PM until 2:30 PM. There was no documentation why the BFR was not delivered at the ordered rate of 250. Review of the 1/31/2024 Hemodialysis Flowsheet revealed the BFR was 350 from 11:01 AM until 2:32 PM. The DFR was 700 from 11:01 AM until 2:32 PM. There was no documentation why the BFR and DFR were not delivered at the ordered rates of 250 and 600. Review of the 2/5/2024 Hemodialysis Flowsheet revealed the BFR was 350 from 11:02 AM until 2:34 PM. There was no documentation why the BFR was not delivered at the ordered rate of 250. Review of the 2/7/2024 Hemodialysis Flowsheet revealed the BFR was 350 from 10:31 AM until 2:31 PM. There was no documentation why the BFR was not delivered at the ordered rate of 250. Review of the 2/9/2024 Hemodialysis Flowsheet revealed the BFR was 200 from 11:35 AM until 12:31 PM, then 350 from 12:31 PM until 2:31 PM. The DFR was 500 from 11:35 AM until 12:31 PM, then 700 from 12:31 PM until 2:31 PM. There was no documentation why the BFR and DFR were not delivered at the ordered rates of 250 and 600. 4. Medical record review for Patient #4 revealed an admission date of 11/22/2018 with diagnoses which included ESRD, Diabetes Mellitus and Hypertension. Review of a 12/04/2023 physician’s order revealed BFR of 350. Review of a 11/30/2022 physician’s order that was renewed on 10/30/2023 revealed DFR of 600. Review of the 2/12/2024 Hemodialysis Flowsheet revealed the BFR was 300 for the duration of the treatment. There was no documentation why the BFR was not delivered at the ordered rate of 350. Review of the 2/21/2024 Hemodialysis Flowsheet revealed the BFR was 300 for the duration of the treatment. There was no documentation why the BFR was not delivered at the ordered rate of 350. Review of the 2/28/2024 Hemodialysis Flowsheet revealed the BFR was 200 from 10:31 AM through 12:15 PM, then the BFR was increased to 300 at 12:46 PM until the treatment ended. There was no documentation why the BFR was not delivered at the ordered rate of 350. Review of the 3/1/2024 Hemodialysis Flowsheet revealed the BFR was 200 from 10:17 AM through 2:00 PM, then the BFR was decreased to 220 at 2:00 PM until the treatment ended. There was no documentation why the BFR was not delivered at the ordered rate of 350. Review of the 3/4/2024 Hemodialysis Flowsheet revealed the BFR was 300 for the duration of the treatment. There was no documentation why the BFR was not delivered at the ordered rate of 350. 5. Medical record review for Patient #5 revealed an admission date of 6/13/2022 with diagnoses which included Diabetes Mellitus and ESRD. Review of a 11/6/2023 physician’s order revealed BFR of 450. Review of a 9/1/2023 physician’s order revealed DFR of 600. Review of the 12/8/2023 Hemodialysis Flowsheet revealed the BFR was 350 from 11:18 AM until 2:15 PM. There was no documentation why the BFR was not delivered at the ordered rate of 450. Review of the 12/18/2023 Hemodialysis Flowsheet revealed the BFR was 400 from 10:31 AM until 1:46 PM. There was no documentation why the BFR was not delivered at the ordered rate of 450. Review of the 12/23/2023 Hemodialysis Flowsheet revealed the BFR was 400 from 11:02 AM until 2:02 PM. The DFR was 800 from 11:02 AM until 2:02 PM. There was no documentation why the BFR and DFR were not delivered at the ordered rates of 450 and 600. Review of the 1/1/2024 Hemodialysis Flowsheet revealed the BFR was 400 from 12:16 PM until 2:31 PM. There was no documentation why the BFR was not delivered at the ordered rate of 450. 6. In an interview on 3/20/2024 at 10:37 AM, the Clinic Manager verified if the BFR and/or DFR prescription was unable to be reached, the staff should document the reason on the Hemodialysis Flowsheet in the comments section.”