Davita Galleria Home Training Dialysis Pd

“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: 46831 Based on policy review, medical record review and interview, the facility failed to ensure 1 of 3 (Patient #1) sampled patients received the prescribed dialysis prescription for BFR receiving home hemodialysis. The findings included: 1. Review of the “Blood Flow Problems” policy revised October 2023 revealed, “...To achieve and maintain prescribed blood flow...Check needle gauge and blood flow prescription...” Review of the “Intradialytic Treatment Monitoring” policy revised October 2024, revealed, “...To guide treatment checks, monitoring during dialysis and documentation for every patient in conformity with his/her individual plan of care...Changes are reported to the registered nurse; appropriate action is taken and documented, including patient response...” Review of the “Post Treatment Patient Assessment” policy revised October 2020 revealed, “...The registered nurse notifies the physician as needed of changes in patient status...All findings, interventions and patient response are documented in the patient’s medical record...” 2. Medical record review for Patient #1 revealed an admission date of 08/15/2023 with diagnoses that included Hypertension/Large Vessel Disease and ESRD. A physician’s order dated 05/15/2025 revealed dialysis 4 times per week for 3 hours with a BFR of 350. Review of the 05/15/2025 Home Hemodialysis Flowsheet revealed the BFR was 400 from 7:03 AM to 7:57 AM; and the BFR was 450 from 7:58 AM to 10:30 AM, at the end of treatment. There was no documentation for the reason the BFR was not administered as prescribed. There was no documentation the registered nurse or the physician was notified of the BFR not being administered at the prescribed rate. Review of the 05/16/2025 Home Hemodialysis Flowsheet revealed the BFR was 450 from 7:17 AM to 9:51 AM at the end of treatment. There was no documentation for the reason the BFR was not administered as prescribed. There was no documentation the registered nurse or the physician was notified of the BFR not being administered at the prescribed rate. Review of the 05/19/2025 Home Hemodialysis Flowsheet revealed the BFR was 450 from 7:38 AM to 10:58 AM at the end of treatment. There was no documentation for the reason the BFR was not administered as prescribed. There was no documentation the registered nurse or the physician was notified of the BFR not being administered at the prescribed rate. Review of the 05/24/2025 Home Hemodialysis Flowsheet revealed the BFR was 450 from 1:22 PM to 5:06 PM at the end of treatment. There was no documentation for the reason the BFR was not administered as prescribed. There was no documentation the registered nurse or the physician was notified of the BFR not being administered at the prescribed rate. Review of the 05/25/2025 Home Hemodialysis Flowsheet revealed the BFR was 450 from 10:07 AM to 1:36 PM at the end of treatment. There was no documentation for the reason the BFR was not administered as prescribed. There was no documentation the registered nurse or the physician was notified of the BFR not being administered at the prescribed rate. Review of the 05/29/2025 Home Hemodialysis Flowsheet revealed the BFR was 450 from 11:31 AM to 2:45 PM at the end of treatment. There was no documentation for the reason the BFR was not administered as prescribed. There was no documentation the registered nurse or the physician was notified of the BFR not being administered at the prescribed rate. Review of the 05/30/2025 Home Hemodialysis Flowsheet revealed the BFR was 450 from 2:07 PM to 4:32 PM at the end of treatment. There was no documentation for the reason the BFR was not administered as prescribed. There was no documentation the registered nurse or the physician was notified of the BFR not being administered at the prescribed rate. Review of the 06/01/2025 Home Hemodialysis Flowsheet revealed the BFR was 450 from 1:10 PM to 4:37 PM at the end of treatment. There was no documentation for the reason the BFR was not administered as prescribed. There was no documentation the registered nurse or the physician was notified of the BFR not being administered at the prescribed rate. 3. During an interview on 06/03/2025 at 1:15 PM, RN #1 confirmed the physicians order for Patient #1’s BFR was 350 and verified the home hemodialysis flowsheets showed a BFR of 450 from 05/15/2025 to 06/01/2025. RN #1 then stated, “...[Patient #1] should have called and reported she had reached the 450 BFR...” During an interview on 06/03/2025 at 2:20 PM, the DHD stated the BFR should have been run at the prescribed rate ordered by the physician. During an interview on 06/04/2025 at 10:35 AM, the MCS stated the BFR should be run at the prescribed rate. If unable to run at the prescribed rate, there must be documentation of why the prescribed rate could not be reached and notification of the charge nurse and physician on the home hemodialysis flowsheets.”