Midtown Kidney Center

“MD RESP-ENSURE ALL ADHERE TO P&P CFR(s): 494.150(c)(2)(i) The medical director must- (2) Ensure that- (i) All policies and procedures relative to patient admissions, patient care, infection control, and safety are adhered to by all individuals who treat patients in the facility, including attending physicians and nonphysician providers; This Standard is not met as evidenced by: 30124 Based on observation, interview and record review the facility’s failed to ensure nursing were immediately notified of any abnormal finding outside of any patient specific ordered parameters discovered during pre-treatment, intradialytic or post treatment to ensure the nurse assess the patient to see if clinical interventions are necessary in 4 of 7 patients. (Patient ID #s 1, 3, 4, & 5). This failed practice has the potential of affecting all 72 of the current in patients in the facility receiving hemodialysis and who experience a change in condition during hemodialysis treatment. Policy Reviewed: Review of the facility’s current policy titled “Patient Assessment and Monitoring”, Fresenius Kidney Care, Clinical Services; Published 05/01/2023, reference Number: 45284, Version: 4. Purpose: The purpose of this policy is to provide guidance to FKC direct patient care staff on assessment and monitoring patients before, during and after treatment. Responsibility: Direct patient care staff (RN, LPN/LVN, PCT (as defined by job description, licensure, certification, state and federal regulations). Data Collection: Direct patient care staff may collect data such as weight, BP, pulse, respirations, temperature, general observations, access, and complaints reported by the patient. If the PCT/LPN note any changes or abnormal findings in the patient’s condition or vascular access are observed or reported by the patient, or the patient was hospitalized, the registered nurse must assess the patient. The RN will notify the patient’s physician/physician extender of any abnormal findings, if necessary, based on clinical judgment for additional instruction. The Registered Nurse will assess/re-assess any findings addressed pre or during treatment as needed. 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. Document machine parameters and safety checks every 30 or more often as needed but not to exceed 45 minutes or per state regulations. Pulse: Record pulse. Verify pulses manually if automated readings display below 60 or greater than 100 beats per minute. Report to the nurse patients whose heart rates have dropped below 60, risen above 100 or become irregular. PCT To RN Reporting: During Dialysis: Pulse: <60 or >110, Increased or decreased by ?15. Reporting - “RN notified”, Troubleshooting - “per RN”. Post Dialysis: Pulse: : <60 or >110 Findings: Record review on 12/08/2023 of selected patient records along with Clinical Manager, Staff ID #A identified pulse reeding that were out of parameters and had no documentation they were reported to the registered nurse and no intervention or reassessment by the registered nurse. Patient ID #1 11/30/2023 - Pre-treatment pulse 67 taken by PCT (Patient Care Technician), Staff ID #E, treatment initiated by Staff ID #E at 05:41 AM, pulse 95, 06:01 AM pulse 78, 06:32 AM pulse 57, 07:00 AM pulse 60, 07:35 AM pulse 92, 08:02 AM pulse 65, 08:32 pulse 86. No documentation the nurse was notified of heart rate out of parameters or reassessment by the nurse. 11/25/2023 - Pre-treatment pulse 69 by PCT, Staff ID #F 05:31 AM, 07:38 AM pulse 50, 08:01 pulse 50, 08:32 AM pulse 78, 09:31 AM pulse 53, 09:49 AM pulse 53. No documentation the nurse was notified of heart rate out of parameters or reassessment by the nurse. Patient ID #3 12/06/2023 - Pre-treatment pulse 55 by PCT, Staff ID #G at 09:29 AM, treatment initiated at 09:36 AM by PCT #G with pulse 57, 09:59 AM pulse 55, 10:37 AM pulse 57. No documentation the nurse was notified of heart rate out of parameters or reassessment by the nurse. 12/01/2023 - Pre-treatment pulse 65 by PCT, Staff ID #G at 09:28 AM, 12:02 PM pulse 59, 12:31 PM pulse 57, 13:36 pulse 59. Post dialysis 13:36 PM pulse documented as 54 by PCT #G. No documentation the nurse was notified of heart rate out of parameters or reassessment by the nurse. Patient ID #4 12/06/2023 - Pre-treatment pulse 93 by PCT, Staff ID #H at 08:55 AM, treatment initiated at 09:07 AM by PCT #H with pulse 64, 10:33 AM pulse 59, 11:31 AM pulse 59. No documentation the nurse was notified of heart rate out of parameters or reassessment by the nurse. Post assessment registered nurses, Staff ID #I noted, “Treatment ended without complaints. Patient tolerated treatment well. Vitals within limits. Patient leaves clinic via wheelchair, awake, oriented x 3. No documentation that the patient’s pulse was out of parameters”. 12/04/2023 - Pre-treatment pulse 68 by PCT, Staff ID #H at 09:00 AM, treatment initiated at 09:12 AM by PCT #H with pulse 65. 10:36 AM pulse 59, 11:01 AM pulse 54, 12:06 PM pulse 49, 12:30 PM pulse 57. No documentation the nurse was notified of heart rate out of parameters or reassessment by the nurse. 11/29/2023 - Pre-treatment pulse 68 by PCT, Staff ID #H at 08:53 AM, treatment initiated at 09:01 AM by PCT #H with pulse 64. 10:30 AM pulse 57, 11:31 AM pulse 58, 12:02 pulse 55. 12:32 treatment completed by Staff ID #H with post pulse 58. No documentation the nurse was notified of heart rate out of parameters or reassessment by the nurse. Post register nurse note, “treatment ended without complaints. Patient tolerated treatment well. UF (ultrafiltration) goal met. Vitals within limits. Patient leaves clinic via wheelchair, alert, oriented x 3”. Patient ID #5 12/04/2023 - Pre-treatment pulse 66 by PCT, Staff ID #H at 10:06 AM, treatment initiated at 10:06 AM by PCT #H with pulse 61. 10:35 AM pulse 57, 11:01 pulse 58, 12:07 PM pulse 57. No documentation the nurse was notified of heart rate out of parameters or reassessment by the nurse. 11/29/2023 - Pre-treatment pulse 76 by PCT, Staff ID #H at 09:54 AM, treatment initiated at 10:06 AM by PCT #H with pulse 63. 10:31 AM pulse 59, 11:03 AM pulse 57, 13:31 PM pulse 58, 13:51 pulse 57. No documentation the nurse was notified of heart rate out of parameters or reassessment by the nurse. Interview: During an interview on the afternoon of 12/08/2023 with the Clinic Manager, Staff ID #A confirmed the above finding and confirmed that heart rates below 60 that were out of the ordered parameters should have been reported to the charge nurse for reassessment of the patient.”