Dialysis Care Center Crossville

“PA-DIALYSIS ACCESS TYPE & MAINTENANCE CFR(s): 494.80(a)(8) The patient’s comprehensive assessment must include, but is not limited to, the following: (8) Evaluation of dialysis access type and maintenance (for example, arteriovenous fistulas, arteriovenous grafts and peritoneal catheters). This Standard is not met as evidenced by: 40606 Based on facility policy review, observation and interview, the facility failed to follow safety procedures to check for pulsation (thrill) of the hemodialysis access in 1 of 1 first shift patients observed with a clamp used to stop bleeding at the end of the dialysis treatment. The findings include: Review of the facility’s policy, “Using Vascular Access Clamps,” dated 12/15/2017, showed “...The purpose of this policy and procedure is to provide guidance and direction for using vascular access clamps on the dialysis vascular access...Apply a non-occluding spring loaded vascular access clamp over the gauze pad covering the needle insertion site...During use, the thrill [a vibration that can be felt] and bruit [swishing sound, heard from a stethescope of dialysis access] of the access will be checked above and below the clamp to prevent occlusion of the access site...” Observation of first shift patients during termination of dialysis on 6/30/2025 at 9:45 AM, revealed Certified Clinical Hemodialysis Technician (CCHT) A removed the first dialysis access needle of the first shift patient seated at station 4, applied a clamp, then exited the station. CCHT A failed to assess the patient’s dialysis access for pulsation. Continued observation revealed at 10:00 AM, CCHT A re-entered station 4 to remove the clamp and remove the second needle. At 10:14 AM, CCHT A removed the second dialysis access needle of the first shift patien, applied pressure as the clamp was placed over the needle site and exited the station. CCHT A failed to follow the facility’s policy and procedure by not assessing for pulsation of the access after the clamp was applied. During an interview with the Clinical Manager on 7/2/2024 at 3:55 PM, in the conference room, it was confirmed CCHT A left station 9 on two occasions during the termination of dialysis without checking for the thrill and bruit above and below the clamp, after being placed over the dialysis access.”

“MR-COMPLETE, ACCURATE, ACCESSIBLE CFR(s): 494.170 The dialysis facility must maintain complete, accurate, and accessible records on all patients, including home patients who elect to receive dialysis supplies and equipment from a supplier that is not a provider of ESRD services and all other home dialysis patients whose care is under the supervision of the facility. This Standard is not met as evidenced by: 40606 Based on review of facility policy, medical record review and interview, the facility failed to ensure the transcription of physician orders were accurate and complete for 2 patients (Pt #2 and Pt #5) of 7 records reviewed. The findings include: Review of the facility policy, “Initiation of Home Dialysis Prescription,” revised 10/6/2020, showed “...an appropriate peritoneal dialysis (PD) prescription meets the dialysis needs of the patient. An appropriate PD prescription includes, but is not limited to the following: number of exchanges or cycles...volume of fluid...dwell time...drain time...concentration of glucose...use of automated, a manual, or a combination...the physician completes the initial treatment prescription...” Medical record review revealed Patient #2 was admitted to the facility for in-center hemodialysis on 9/1/2024, with diagnoses including Anemia and End Stage Renal Disease. Medical record review revealed Patient #2 was trained in PD in March/April of 2025, was hospitalized in May, and attained the first adequate Kt/V in June with a value of 2.41. Medical record review of Pt #2 revealed the PD treatment prescription listed on the Nephrologist Rounding Sheets, the IDT (Interdisciplinary Team) Treatment Plan, and the Physician’s order did not match the current treatment regime. The initial PD order was for CAPD (continuous ambulatory PD), 2 exchanges a day using a 2L (liter) bag of 1.5% dianeal fluid (fluid that contains dextrose and electrolytes used for peritoneal dialysis). Medical record review of Pt #2’s Nursing Treatment Documentation revealed a note created by RN (registered nurse) #1 for a PD treatment change to 3 times a day using one 2 L bag of 1.5% dianeal fluid in the AM, a 2 L bag of 2.5% dianeal fluid in the afternoon, and a 2 L bag of 1.5% dianeal fluid in the evening. Medical record review of Pt #2’s Treatment Records revealed this was the treatment being completed each day. Review of physician orders revealed a new order was not placed for the change in the daily PD treatments in the EMR (Electronic Medical Record). Interview on 7/1/2025 at 11:00 AM, with RN #1 confirmed she received the orders for the change in Pt #2’s treatment plan and she had not placed the new treatment order in the computer system. Medical record review revealed Patient #5 was admitted to the facility for PD training on 3/25/2025, with diagnoses including Diabetes, Anemia, and End Stage Renal Disease. Medical record review revealed Pt #5’s physician prescribed treatment listed on the Nephrologist Rounding Sheets, the IDT Treatment Plan, and the Physicians order did not match the current treatment regime. Review revealed the initial treatment order was for CCPD (continuous cycling PD) using 1.5% dianeal fluid with a fill volume of 1000 ml (milliliters) each, for 4 cycles over 8 hours. Review of the June treatment records revealed Pt #5 was receiving CCPD using 1.5% and 2.5% dianeal fluid with a fill volume of 2000 ml each, for 5 cycles over 8 hours. Medical record review revealed a new physician order was not placed in the EMR. Interview on 7/2/2025 at 11:25 AM, with RN #2 confirmed she did not place the new order into the system timely. She confirmed she forgot to place the order.”