Fmc Dialysis Services of Mckinney

“Development of Communication Plan CFR(s): §403.748(c), §416.54(c), §418.113(c), §441.184(c), §460.84(c), §482.15(c), §483.73(c), §483.475(c), §484.102(c), §485.68(c), §485.542(c), §485.625(c), §485.727(c), §485.920(c), §486.360(c), §491.12(c), §494.62(c). (c) The [facility] must develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws and must be reviewed and updated at least every 2 years [annually for LTC facilities]. This Standard is not met as evidenced by: 26190 Based on document review, interview and policy review the facility staff failed to develop a communication plan that would enable the facility to communicate with Federal, and State officials to ensure continuation of patient care. This deficient practice had the potential to affect all patients at this facility. Findings include: Review of the facility’s plan titled, “Fresenius Kidney Care 2411-Mckinney Emergency Plan” dated 08/08/23 indicated no documentation of how the facility will collaborate with the Federal and State officials to ensure continuation of patient care. During an interview on 02/21/24 at 11:00 AM, the Clinical Manager (CM) stated that he/she had made several attempts to have open communication with the City of McKinney but has not received any communication from the city. The CM was not aware the facility’s emergency plan needed to include how the facility would collaborate with Federal and State emergency preparedness staff. During an interview on 02/21/24 at 11:45 AM, the Director of Operations (DO) was unable to verbally explain how the facility would collaborate with Federal and State officials in the event of an emergency. The DO stated that 911 would be used for an emergency in the local area and the facility’s corporate communication team would be able to assist the facility with any disaster. Review of the facility’s plan titled “Fresenius Kidney Care 2411-Mckinney Emergency Plan” dated 08/08/23 stated “Section 1 - Introduction ...3. Communication plan: Each facility will develop and maintain a communication plan that complies with both Federal and State law. Patient care must be well-coordinated within the facility, across health care providers and with State and local public health departments and emergency systems.” The facility’s plan included information regarding collaboration between the facility’s disaster team and their corporate communications team for disasters.”

“Emergency Officials Contact Information CFR(s): §403.748(c)(2), §416.54(c)(2), §418.113(c)(2), §441.184(c)(2), §460.84(c)(2), §482.15(c)(2), §483.73(c)(2), §483.475(c)(2), §484.102(c)(2), §485.68(c)(2), §485.542(c)(2), §485.625(c)(2), §485.727(c)(2), §485.920(c)(2), §486.360(c)(2), §491.12(c)(2), §494.62(c)(2). [(c) The [facility] must develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws and must be reviewed and updated at least every 2 years [annually for LTC facilities]. The communication plan must include all of the following: (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) Other sources of assistance. *[For LTC Facilities at §483.73(c):] (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) The State Licensing and Certification Agency. (iii) The Office of the State Long-Term Care Ombudsman. (iv) Other sources of assistance. *[For ICF/IIDs at §483.475(c):] (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) Other sources of assistance. (iii) The State Licensing and Certification Agency. (iv) The State Protection and Advocacy Agency. This Standard is not met as evidenced by: 26190 Based on document review, interview and policy review the facility failed to have a communication plan that included the contact information for Federal, State, and regional emergency preparedness staff. This deficient practice has the potential to affect all patients at this facility. Findings include: Review of the facility’s plan titled, “Fresenius Kidney Care 2411-Mckinney Emergency Plan” dated 08/08/23 indicated no documentation of the contact information for Federal, State, and regional emergency preparedness staff. During an interview on 02/21/24 at 11:00 AM, the Clinical Manager, (CM)stated that he/she was not aware the facility’s emergency plan needed to include contact information for Federal, State, and regional emergency preparedness staff. Review of the facility’s plan titled “Fresenius Kidney Care 2411-Mckinney Emergency Plan” dated 08/08/23 stated “Section 1 - Introduction ...3. Communication plan: Each facility will develop and maintain a communication plan that complies with both Federal and State law. Patient care must be well-coordinated within the facility, across health care providers and with State and local public health departments and emergency systems.” The facility’s plan included contact information for the facility’s disaster team and the corporate communications team for disasters. The plan did not include any contact information for Federal, State, and regional emergency preparedness staff.”

“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 patients washed or sanitized hands after holding access sites (A vascular access is created so that blood can be drawn from the body and run through a dialysis machine, where excess fluid and toxins are removed from the blood. The filtered blood then flows back through the access into the body) for two of two observations. The failure for patients to wash or sanitize hands after holding access site had the potential for cross contamination and could affect 86 in-center patients. Findings include: Observation on 02/19/24 at 2:15 PM revealed the patient at Station 2 applied pressure to the right upper arm access site until bleeding had stopped. When finished the patient removed his/her glove and Certified Clinical Hemodialysis Technician (CCHT) 6 assisted the patient to the scale to retrieve his/her weight. The patient did not wash or sanitize hands and CCHT 4 did not instruct or encourage the patient to wash or sanitize hands. During an interview on 02/19/24 at 3:00 PM CCHT 6 confirmed the patient did not wash or sanitize hands and that he/she should have offered or encouraged the patient to hand sanitize or wash hands to prevent cross contamination. Observation on 02/20/24 at 11:15 AM the patient at Station 8 held pressure to his/her left lower arm access site. After the bleeding had stopped CCHT 5 taped up the access site. The patient removed his/her glove, gathered belongings and CCHT 5 walked with the patient to the scale to retrieve the patient’s weight. The patient left the unit without washing or sanitizing hands and CCHT 5 did not instruct or encourage the patient to wash or sanitize hands. During an interview on 02/20/24 at 11:45 AM CCHT 5 acknowledged the patient at Station 8 did not wash or sanitize hands after holding access sites but should have to prevent cross contamination. During an interview on 02/21/24 at 12:45 PM the Clinical Manager confirmed patients should wash or sanitize hands per facility policy after holding access sites at the end of treatment to prevent cross contamination of blood borne pathogens. Review of the facility policy titled; “Hand Hygiene” revised 11/06/23 revealed the following: “ ...Hand Hygiene: Patients; Patients should perform hand hygiene if able prior to and after each dialysis treatment as needed. Direct patient care staff will demonstrate how to operate the sinks. Demonstrate hand washing to patients who are able to perform hand washing. and explain risk of contamination with regard to their vascular access and hands to all patients. Gloves must be provided to patients when performing procedures which risk exposure to blood or body fluids, such as when self-cannulating or holding access sites post treatment to achieve hemostasis. To help ensure the prevention of cross contamination to their family members or other patients, hand hygiene must be performed ...””

“IC-ASEPTIC TECHNIQUES FOR IV MEDS CFR(s): 494.30(b)(2) [The facility must-] (2) Ensure that clinical staff demonstrate compliance with current aseptic techniques when dispensing and administering intravenous medications from vials and ampules; and This Standard is not met as evidenced by: 28297 Based on observation, interview and policy review, the facility failed to ensure one of three Registered Nurses (RN) 3, administered a medication to ensure a patient received the full dose of medication. The failure to administer medications correctly resulted in a patient not receiving the full dose of medication as ordered by the physician and could affect 86 patients. Findings include: Observation on 02/20/24 at 11:55 AM revealed RN 3 administered a medication through the pigtail port of Patient (P)12) venous drip chamber. RN3 pushed two different syringes of medication through the pigtail port of the venous chamber and clamped the line. RN3 did not flush medication through with normal saline to ensure that P12 received the entire dose of Parsivib 15 milligrams (mg). During an interview on 02/20/21 at 12:00 PM RN 3 stated he/she had completed P12’s medication administration. He/she acknowledged that some of the medication was not given because he/she did not clear the line with air or saline. During an interview on 02/21/24 at 12:45 PM the Clinical Manager stated he/she could not confirm that the entire dose of medication was given on 02/20/24 at 11:55 AM as he/she was not present during the medication administration. The Clinical Manager stated he/she wasn’t sure there was clear instructions in the policy regarding Intravenous (IV) medications administration and that he/she would need to follow up with Clinical Services regarding correct policy and procedures for IV medication administration through the venous drip chamber medication pigtail. Review of the facility’s policy “Medication Preparation and Administration Procedure,” revised 02/06/23 revealed the following: “ ...Medications in syringe with Luer lock will be given IV push through the venous chamber medication pigtail ...””

“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: 28297 Based on observation, interview, and policy review, the facility failed to ensure a patient (P)13) wore a mask that was covering his/her nose during the discontinuation of dialysis via a Central Venous Catheter (CVC) (thin, flexible tube is inserted into a vein, usually below the collarbone. It is guided (threaded) into a large vein above the right side of the heart) for one of two observations. The failure to ensure the mask was covering the nose as required by the facility’s policy, had the potential for contamination of the CVC and had the potential for increased the risk of infections, and could affect 10 of 86 patients that have CVCs in the facility. Findings include: During an observation on 02/20/24 at 10:45 AM Registered Nurse (RN)3 completed P13’s CVC discontinuation of the dialysis treatment via the CVC, however, P13’s mask remained below his/her nose the entire time. During an interview on 02/20/24 at 11:45 AM RN 3 confirmed that P13’s mask was not covering his/her nose as required to prevent contamination. During an interview on 02/21/24 at 12:45 PM the Clinical Manager confirmed it was part of the facility policy for the patient to wear a mask covering the mouth and nose during discontinuation of dialysis via a CVC to prevent contamination of the CVC. Review of the facility’s policy titled, “Initiation and Discontinuation of Treatment Using a Central Venous Catheter,” revised 07/05/22 revealed “ ...A mask must be worn that covers the nose and mouth by staff, patient and care partner for all procedures that require accessing the catheter ...””