Dci Kingsport

“ESRD Patient Orientation Training CFR(s): The dialysis facility must provide appropriate orientation and training to patients, including the areas specified in paragraph (d)(1) of this section. This Standard is not met as evidenced by: 18784 Based on review of a facility procedure, medical record review, observation and interview, the facility failed to provide the required admission and quarterly patient education for emergency evacuation for 5 patients (#7, #8, #9, #10 and #11) of 5 patients reviewed. The findings include: Review of a procedure to address emergency evacuation of patients, dated 1/2024, showed “...Review of SUBJECT: Patient education “How to get off the dialysis machine” for Emergency Evacuation. PURPOSE: To ensure safe and secure disconnection of patient in the event evacuation is needed...With admission and quarterly education there is material given to patients...” Patient #7 was admitted on 3/1/5/2023 for in-center hemodialysis (HD) with diagnoses including End Stage Renal Disease. During observation at 9:45 AM on 4/8/2024, of Patient #7 and interview, it was noted he was receiving the HD treatment with a Central Venous Catheter (CVC) and his wife was seated close to him. During the interview, both the patient and his wife stated they had not received any education related to emergency evacuation. Patient #8 was admitted on 12/29/2023 for in-center HD with diagnoses including End Stage Renal Disease. During observation and interview at 10:15 AM on 4/8/2024 of Patient #8, it was noted he was receiving the HD treatment with a CVC. Patient #8 stated he recently had to stop peritoneal dialysis and begin in-center HD. The patient stated he walked independently. Interview showed he had not received any education related to emergency evacuation. Patient #9 was admitted on 4/5/2023 for in-center HD with diagnoses including Diabetes, Heart Disease, and End Stage Renal Disease. During observation and interview at 10:35 AM on 4/8/2024 of Patient #9, it was noted he was receiving the HD treatment with a CVC and wearing oxygen supplementation. Patient #9 stated he recently had to stop using his arterio-venous fistula due to complications continuing to be addressed by the surgeon. The patient stated he recently started using a walker and it was working well for him. Interview showed he had not received any education related to emergency evacuation. Patient #10 was admitted on 2/10/2023 for in-center HD with diagnoses including End Stage Renal Disease. During observation and interview at 11:00 AM on 4/8/2024, of Patient #10, he shared he was a chemical engineer. He stated he had not received emergency evacuation treatment, but he had asked the staff previously what would happen if the power went out and they showed him the cranking procedure (for the blood pump). Patient #11 was admitted on 9/15/2023 for in-center HD with diagnoses including End Stage Renal Disease. During an observation and interview on 4/8/2024 at 11:05 AM, when questioned about what to do in case of an emergency, Patient #11 said he didn’t know. He confirmed he was independent with walking and he was unaware of any teaching about what to do in case of an emergency. During an interview on 4/10/2022 at 8:45 AM, the Clinical Manager (CM) confirmed she had not located any documentation of emergency evacuation education for Patients #7, #8, #9, #10, or #11 at admission or quarterly. Further interview confirmed the CM was developing a plan to provide the required education on admission and quarterly for all patients.”

“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: 40606 Based on facility policy review, observation and interview, the facility failed to ensure patients, after the hemodialysis treatment ended, performed disinfection of their hands prior to exiting the treatment area for 2 of 5 observations of hand disinfection after the treatment ended. The findings include: Review of the facility policy titled, “Handwashing” dated 3/20/2003, showed “...Purpose...To prevent the transmission of infectious pathogens through cross contamination by the patient caregiver...Hand washing should be done...Before and after each patient contact...After handling of equipment and supplies...After removal of gloves...” Review of the facility policy titled, “General Principles of Infection Control” dated 11/2021, showed “...This program is designed to minimize or eliminate infectious exposure primarily through the use of Personal Protective Equipment as a barrier...” During an observation on the dialysis treatment area, with 11 patients and 5 staff members present, on 4/8/2024 at 11:10-11:13 AM, the patients who received treatment in stations #1 and #3, exited their stations without sanitizing hands and obtained post treatment weights. Observation continued and both patients exited the treatment area without disinfecting their hands. During an observation of initiation of a dialysis treatment using a Central Venous Catheter (CVC) on 4/8/2024 at 11:19 AM, RN #1 entered station 13 and performed a dressing change for the CVC. RN #1 and the patient in station 13 wore face masks covering their mouth and nose. Observation continued and while the CVC’s exit site was open to air, without a dressing, a Certified Clinical Hemodialysis Technician (CCHT) #1 entered station 13 with her mask pushed down, covering only the chin. CCHT #1 stood directly over the CVC’s uncovered exit site, spoke to the RN, and then exited the station. During an interview on 4/10/2024 at 12:34 PM, the Clinical Manager (CM) confirmed patients were expected to adhere to the facility’s handwashing policy and sanitize their hands prior to leaving the treatment area. The CM confirmed the observation of CCHT #1 showed she failed to follow the facility’s infection control procedures by entering station 13, during a dressing change, and not wearing a face mask that covered her mouth and nose.”