Fmc Raleigh Bartlett

“IC-STAFF EDUCATION-CATHETERS/CATHETER CARE CFR(s): 494.30(a)(2) Recommendations for Placement of Intravascular Catheters in Adults and Children I. Health care worker education and training A. Educate health-care workers regarding the ... appropriate infection control measures to prevent intravascular catheter-related infections. B. Assess knowledge of and adherence to guidelines periodically for all persons who manage intravascular catheters. II. Surveillance A. Monitor the catheter sites visually of individual patients. If patients have tenderness at the insertion site, fever without obvious source, or other manifestations suggesting local or BSI [blood stream infection], the dressing should be removed to allow thorough examination of the site. Central Venous Catheters, Including PICCs, Hemodialysis, and Pulmonary Artery Catheters in Adult and Pediatric Patients. VI. Catheter and catheter-site care B. Antibiotic lock solutions: Do not routinely use antibiotic lock solutions to prevent CRBSI [catheter related blood stream infections]. This Standard is not met as evidenced by: 33763 Based on policy review, observation and interview, the facility failed to ensure measures to prevent the potential spread of infection were followed by 1 of 1 (RN #1) nurses observed discontinuing hemodialysis treatment via a CVC. The findings included: 1. Review of the facility policy titled, “Termination of Treatment Using a Central Venous Catheter and Optiflux Single Use Ebeam Dialyzer” dated 2/7/2022 revealed, “...Prior to Termination...Ensure that a clean under pad is below the catheter limbs...” 2. Observations on the treatment floor at Station #7 on 9/9/2024 beginning at 9:46 AM revealed RN #1 failed to place a new under pad below Patient #5’s CVC limbs prior to discontinuing the dialysis treatment. 3.Observations on the treatment floor at Station #10 beginning at 4:08 PM revealed RN #1 failed to place a new under pad below Random Patient #1’s CVC limbs prior to discontinuing the dialysis treatment. During an interview on 9/10/2024 at 12:14 PM, the CM verified a clean barrier should be placed under the CVC limbs prior to discontinuing the dialysis treatment.”

“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: 33763 Based on policy review, medical record review and interview, the facility failed to ensure patients undergoing hemodialysis treatments were monitored every 30 minutes per facility policy for 4 of 5 (Patient #1, #2, #3 and #5) sampled patients. The findings included: 1. Review of the facility policy titled, “Patient Assessment and Monitoring” dated 5/1/2023 revealed, “...During Treatment...Obtain blood pressure and pulse rate every 30 minutes or more as needed but not to exceed 45 minutes or per state regulations...” Review of the facility policy titled, “Patient Monitoring and Safety Checks During Hemodialysis Treatment” dated 9/5/2023 revealed, “...Monitor and document every 30 minutes or more frequently as needed but not to exceed 45 minutes or per state regulations...Patient Monitoring includes...Blood pressure, pulse, respirations...” 2. Medical record review for Patient #1 revealed an admission date of 2/7/2020 with diagnoses which included Type 2 Diabetes Mellitus and End Stage Renal Disease. Review of the physician’s orders dated 5/31/2024, 7/22/2024, 7/29/2024, 8/9/2024, and 8/12/2024 revealed the Patient was to receive in-center hemodialysis treatments 3 times a week via an AV Fistula. Review of the Treatment Sheet dated 6/5/2024 revealed the treatment was initiated at 3:15 PM and ended at 5:00 PM. There was no documentation facility staff assessed Patient #1’s blood pressure from 3:15 PM until 4:06 PM, a total of 51 minutes later, and from 4:06 PM until 5:00 PM, a total of 54 minutes later. Review of the Treatment Sheet dated 7/26/2024 revealed the treatment was initiated at 2:15 PM and ended at 5:00 PM. There was no documentation facility staff assessed Patient #1’s blood pressure from 2:15 PM until 3:02 PM, a total 47 minutes later. Review of the Treatment Sheet dated 8/5/2024 revealed the treatment was initiated at 1:15 PM and ended at 5:00 PM. There was no documentation facility staff assessed Patient #1’s blood pressure from 3:36 PM until 5:00 PM, a total of 1 hour and 24 minutes later. Review of the Treatment Sheet dated 8/7/2024 revealed the treatment was initiated at 1:15 PM and ended at 5:00 PM. There was no documentation facility staff assessed Patient #1’s blood pressure from 1:15 PM until 2:03 PM, a total of 48 minutes later. Review of the Treatment Sheet dated 8/9/2024 revealed the treatment was initiated at 1:15 PM and ended at 4:10 PM. There was no documentation facility staff assessed Patient #1’s blood pressure from 1:15 PM until 2:04 PM, a total of 49 minutes later. 3. Medical record review for Patient #2 revealed an admission date of 12/26/2018 with diagnoses which included Hypertensive Chronic Kidney Disease and End Stage Renal Disease. Review of the physician’s orders dated 5/31/2024, 6/19/2024, and 9/4/2024 revealed the Patient was to receive in-center hemodialysis treatments 3 times a week via an AV Fistula. Review of the Treatment Sheet dated 8/28/2024 revealed the treatment was initiated at 1:15 PM and ended at 5:15 PM. There was no documentation facility staff assessed Patient #2’s blood pressure from 2:33 PM until 3:33 PM, a total of 1 hour later. Review of the Treatment Sheet dated 8/9/2024 revealed the treatment was initiated at 1:15 PM and ended at 5:28 PM. There was no documentation facility staff assessed Patient #2’s blood pressure from 1:15 PM until 2:00 PM, a total of 45 minutes later. Review of the Treatment Sheet dated 9/2/2024 revealed the treatment was initiated at 1:15 PM and ended at 5:10 PM. There was no documentation facility staff assessed Patient #2’s blood pressure from 1:15 PM until 2:00 PM, a total of 45 minutes later. 4. Medical record review for Patient #3 revealed an admission date of 9/25/2023 with diagnoses of End Stage Renal Disease. Review of the physician’s orders dated 7/26/2024 revealed the Patient was to receive in-center hemodialysis treatments 3 times a week via an AV fistula. Review of the Treatment Sheet dated 8/12/2024 revealed the treatment was initiated at 7:45 AM and ended at 11:50 AM. There was no documentation facility staff assessed Patient #3’s blood pressure from 7:45 AM until 8:32 AM, a total of 47 minutes later. Review of the Treatment Sheet dated 8/16/2024 revealed the treatment was initiated at 7:18 AM and ended at 11:23 AM. There was no documentation facility staff assessed Patient #3’s blood pressure from 7:18 AM until 8:12 AM, a total of 54 minutes later. 5. Medical record review for Patient #5 revealed an admission date of 1/11/2023 with diagnoses of End Stage Renal Disease and Diabetes Mellitus. Review of the physician’s orders dated 8/28/2024 revealed the Patient was to receive in-center hemodialysis treatments 3 times a week via a CVC. Review of the Treatment Sheet dated 8/30/2024 revealed the treatment was initiated at 6:15 AM and ended at 10:03 AM. There was no documentation facility staff assessed Patient #5’s blood pressure from 6:15 AM until 7:05 AM, a total of 50 minutes later. 6. During an interview on 9/10/2024 at 11:17 AM, when asked how often blood pressures should be assessed during hemodialysis treatments, the Area Team Lead stated, “every 30 minutes but the policy says no greater than 45 minutes.””