Dci Beech Lake

“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: 19001 Based on policy review, medical record review and interview, the facility failed to ensure 3 of 4 (Patient #1, 2 and 4) sampled in-center hemodialysis patients received the prescribed dialysis prescription for BFR and/or Heparin. The facility also failed to notify the physician the patient’s dialysis prescription could not be delivered as ordered. The findings included: 1. Review of the facility policy “INITITATION OF THE HEMODIALYSIS TREATMENT FOR AVF/AVG AND CVC” last revised 11/10/16 revealed, “PURPOSE: To identify the steps required to initiate hemodialysis treatment in a safe and efficient manner per the dialysis prescription... Adjusts blood flow rate according to access/physician orders...if unable to obtain ordered BFR, trouble shoot causes and involve CN if needed. Document BFR obtained and efforts resolution...” 2. Review of the facility policy “Darwin Direct (Documentation Incenter Real-Time Electronic Chairside Treatment)” issued December 2018, revealed... “The Heparin Dose should be recorded at least every hour...” 3. Medical record review for Patient #1 revealed an admission date of 8/29/2024 with diagnoses which included ESRD. A physician’s order dated 11/6/2024 revealed dialysis 3 times per week with a prescribed BFR of 400. Review of the 12/18/2024 Hemodialysis Flowsheet revealed the following: 12:02 PM until 12:32 PM, the BFR was 350;and then 300 from 12:32 PM until 3:02 PM (the end of treatment), the BFR was 300. There was no documentation why the BFR was not delivered at the ordered rate of 400. There was no documentation the physician was notified the dialysis prescription was not delivered as ordered.. Review of the 12/20/2024 Hemodialysis Flowsheet revealed the following: 12:32 PM until 2:38 PM (the end of treatment), the BFR was 375. There was no documentation why the BFR was not delivered at the ordered rate of 400. There was no documentation the physician was notified the dialysis prescription was not delivered as ordered.. Review of the 12/23/2024 Hemodialysis Flowsheet revealed the the following: 12:02 PM until 2:41 PM (the end of treatment), the BFR was 350. There was no documentation why the BFR was not delivered at the ordered rate of 400. There was no documentation the physician was notified the dialysis prescription not delivered as ordered.. Review of the 1/1/2025 Hemodialysis Flowsheet revealed the following: 12:01 PM until 2:50 PM (the end of treatment), the BFR was 350. There was no documentation why the BFR was not delivered at the ordered rate of 400. There was no documentation the physician was notified the dialysis prescription was not delivered as ordered.. Review of the 1/3/2025 Hemodialysis Flowsheet revealed the following: 11:32 AM until 2:37 PM (the end of treatment) the BFR was 200. There was no documentation why the BFR was not delivered at the ordered rate of 400. There was no documentation the physician was notified the dialysis prescription was not delivered as ordered. Review of the 1/6/2025 Hemodialysis Flowsheet revealed the following: 12:01 PM until 2:51 PM (the end of treatment), the BFR was 350. There was no documentation why the BFR was not delivered at the ordered rate of 400. There was no documentation the physician was notified the dialysis prescription was not delivered as ordered. 4. Medical record review for Patient #2 revealed an admission date of 12/29/2023 with diagnoses which included Chronic Kidney Disease. A physician’s order dated 12/29/2023 (renewed 12/2/2024) revealed a 5000-unit load of IV Heparin and hourly dose of IV Heparin 500 units for 3 hours during dialysis. Review of the 11/11/2024 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 500 units was not charted as given. There was no documentation why the 500 units of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 11/20/2024 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 500 units was not charted as given. There was no documentation why the 500 units of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 11/29/2024 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 500 units was not charted as given. There was no documentation why the 500 units of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 12/30/2024 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 500 units was not charted as given. There was no documentation why the 500 units of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 1/1/2025 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 500 units was not charted as given. There was no documentation why the 500 units of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 1/3/2025 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 500 units was not charted as given. There was no documentation why the 500 units of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 1/13/2025 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 500 units was not charted as given. The flowsheet revelaed Heparin 0.6 Units was given, with no documentation the 0.6 units of Heparin administered was not included in the total on flowsheet. There was no documentation why the 500 units of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 1/15/2025 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 500 units was not charted as given. There was no documentation why the 500 units of Heparin was not infused. There was no documentation the physician was notified Heparin was not infused as ordered. Review of the 1/17/2025 Hemodialysis Flowsheet revealed the hourly dose of IV Heparin 500 units was not charted as given. There was no documentation why the 500 units 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 #4 revealed an admission date of 7/23/2021 with diagnoses which included ESRD and HTN. A physician’s order dated 12/2/2024 revealed dialysis 3 times per week with a BFR of 425. Review of the 12/18/2024 Hemodialysis Flowsheet revealed the following: 7:03 AM until 9:28 AM (the end of treatment), the BFR was 350. There was no documentation why the BFR was not delivered at the ordered rate of 425. There was no documentation the physician was notified the dialysis prescription was not delivered as ordered. Review of the 12/20/2024 Hemodialysis Flowsheet revealed the following: 6:32 AM until 7:02 AM,the BFR was 300; 7:32 AM until 9:55 AM (the end of treatment), the BFR was 400. There was no documentation why the BFR was not delivered at the ordered rate of 425. There was no documentation the physician was notified the dialysis prescription was not delivered as ordered. Review of the 1/3/2025 Hemodialysis Flowsheet revealed the following: 9:03 AM until 9:58 AM (the end of treatment), the BFR was 300. There was no documentation why the BFR was not delivered at the ordered rate of 425. There was no documentation the physician was notified the dialysis prescription was not delivered as ordered. 6. During an interview on 1/22/2025 at 12:49 PM, the NM verified the staff should document on the hemodialysis flowsheet the reason they are unable to achieve the prescribed BFR during dialysis. During an interview on 1/22/2024 at 1:30 PM the NM stated, “Heparin usage should be noted hourly”. The NM further stated the hourly infusion was programmed into the machine and delivered correctly, but staff were failing to manually enter the infusion amounts on the dialysis flowsheets.”