Fmc Carizzo Springs Kidney Disease Clinic

“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: 28297 Based on observation, interview, and policy review, the facility failed to ensure staff sanitized hands, and changed gloves as required during discontinuation of dialysis for “AV Fistula” (an artery connected to the vein for needle access during hemodialysis) for one of two Patient (P)9) observed AF Fistula discontinuation. The failure to sanitize hands and change gloves had the potential for contamination of the AV access site and this could affect 76 in-center patients. Findings include: Observation on 10/21/24 at 11:45 AM revealed Licensed Vocational Nurse (LVN) 1 was discontinuing the treatment via the AV fistula for P9 at Station 20. LVN reinfused the extracorporeal circuit and disconnected the blood lines then proceeded to lower the footrest on the chair and had the patient get a standing blood pressure. LVN1 handled the patient’s belongings while waiting for the standing blood pressure. P9 sat down after the standing blood pressure and LVN 1 proceeded to remove the patients needles without removing gloves and sanitizing hands as required. During an interview on 10/21/24 at 12:07 PM, LVN 1 confirmed he/she did not change gloves or sanitize hands as required during termination of the treatment and should have to prevent cross contamination of the fistula site. During an interview on 10/24/24 at 10:40 AM, the Clinic Manager confirmed that staff were required to change gloves and sanitize hands after rinsing the patient back and before removing needles to prevent cross contamination of the fistula site. Review of the facility policy “Hand Hygiene,” revised 11/06/23 indicated the following: “ ...Decontaminated using alcohol-based hand rub or by washing hands with antimicrobial soap and water ...after contact with inanimate objects near the patient ...””

“PA-FREQUENCY REASSESSMENT-UNSTABLE Q MO CFR(s): 494.80(d)(2) In accordance with the standards specified in paragraphs (a)(1) through (a)(13) of this section, a comprehensive reassessment of each patient and a revision of the plan of care must be conducted- At least monthly for unstable patients including, but not limited to, patients with the following: (i) Extended or frequent hospitalizations; (ii) Marked deterioration in health status; (iii) Significant change in psychosocial needs; or (iv) Concurrent poor nutritional status, unmanaged anemia and inadequate dialysis. This Standard is not met as evidenced by: 28028 Based on record review, facility policy review, and interview, the facility failed to ensure that patients who met the unstable criteria for extended or frequent hospitalizations and marked deterioration in health status were identified. The facility failed to conduct a comprehensive reassessment and revision of the plan of care for one (P10) of 10 patients sampled. Findings include: Review P10’s “Patient Information form”, provided by the facility, revealed admission date of 11/27/19 for in-center hemodialysis treatment. Review of the “hospitalization log” revealed P10 was hospitalized 06/29/24-07/27/24 (28 days) for acquired absence of limb, unspecified. Review of the “Nursing progress note” provided by the facility, dated 07/13/24, revealed patient called the clinic and reported he had an amputation to his left limb on 07/01/24 and verbalized he will be transferred to rehab sometime next week. Review of the “treatment flowsheets” revealed P 10 returned for in-center hemodialysis treatment on 08/20/24. Review of the ‘Registered Dietitian (RD) progress note,” provided by the facility, dated 08/27/24, stated P10 was status-post amputation, now with bilateral above the knee amputation. Review of P10’s last “Plan of Care (POC)” completed by the Interdisciplinary Team (IDT) was dated 05/15/24, during which the patient was deemed stable by the IDT. The “POC” included a patient goal of no hospitalizations, with an intervention to monitor parameters that may lead to hospitalization. Review of the “hospitalization log,” provided by the facility, showed that the patient had been hospitalized on 05/23/24-05/25/24, 06/15/24-06/24/24, and 06/29/24-07/27/24. There was no evidence in the medical record that the IDT had identified the patient as meeting the unstable criteria or that a comprehensive reassessment and POC had been conducted by the IDT. Interview with the Clinic Manager (CM) on 10/22/24 at 1:05 PM, P10’s current “POC” dated 05/15/24, and the reasons for P10’s multiple and extended hospitalizations were reviewed. The CM was asked if the patient had been considered unstable. The CM explained that the computer system alerts staff when a patient should be classified as unstable, but acknowledged, “I guess we missed that one.” Review of the facility’s policy titled, “Comprehensive Interdisciplinary Assessment and Plan of Care,” provided by the facility, dated 07/03/23, outlined the criteria for classifying a patient as unstable. These criteria included, “extended or frequent hospitalizations, specifically a hospitalization lasting more than 15 days with discharge occurring within the last 30 days, or more than three admissions in the last 30 days. Additionally, marked deterioration in health status, requiring the Interdisciplinary Team to identify and document specific reasons, such as changes in ambulation that interfere with the patient’s ability to follow aspects of the treatment plan, is also a criterion. “”