Davita Pin Oak Dialysis

“PR-RECEIVE SERVICES OUTLINED IN POC CFR(s): 494.70(a)(12) The patient has the right to- (12) Receive the necessary services outlined in the patient plan of care described in §494.90; This Standard is not met as evidenced by: 10802 Based on observation, interview, and record review, the facility’s staff failed to administer patients’ hemodialysis treatment based on physician’s orders in 2 of 7 sampled patients; Patient #s 1, 3, Findings: Patient #1 On 07/16/2024 at 9:00 a.m. Patient #1 who is identified in the complaint investigation, was observed on the treatment floor of the facility at station # 13, hemodialysis machine #3. The patient was receiving hemodialysis treatment at a blood flow rate of 400 mls/ minute and dialysate flow rate of 700 mls/ minute. The patient was utilizing dialysate concentrate of 2 mEq potassium , 2.5 mEq calcium and bicarbonate of 31 mEq/L. At the request of the Surveyor, Registered Nurse (D) opened the panel of the hemodialysis machine which indicated a bicarbonate setting of 31 mEq/dl. Review of the patient’s clinical record located in the chairside computer revealed a physician’s order dated 7/11/2024 for bicarbonate setting of 37 mEq. The surveyor immediately notified Registered (D) that the patient’s hemodialysis machine was not set to deliver prescribed bicarbonate of 37 mEq. Registered Nurse (D) states “ I will change the setting.” Review of the treatment sheet located in the chairside computer revealed the patient’s hemodialysis treatment began at 6:45 a.m. with bicarbonate setting at 31 mEq/ L until the Surveyor notified Registered Nurse (D) of the incorrect setting on the patient’s hemodialysis machine. Patient#1 Dialysate flow rate Review of the patient#1’s treatment sheet dated 06/20/2024 revealed a prescription for blood flow rate of 400 mls/ minute and dialysate flow rate of 700 mls/ minute. Review of the patient’s clinical record revealed a physician’s order dated 07/11/2024 for blood flow rate of 400 mls/ minute and dialysate flow rate of 700 mls/ minute. Review of the patient’s treatment sheet dated 06/20/2024 revealed documentation that patient’s blood flow rate was maintained at 350 mls/ minute from 06:04 a.m. to 10:04 a.m., instead of 400 mls/minute as ordered by the patient’s physician. There was no justification documented why the patient’s blood flow rate was not maintained at the prescribed rate of 400 mls/ minute. Review of the patient’s treatment sheet revealed documentation by the patient care technician assigned to the patient, that the patient’s hemodialysis treatment was initiated by the patient care technician at 06:04 a.m. and continued at 10:04 a.m. Review of the treatment sheet revealed documentation by the registered nurse assigned to the patient that she verified the patient’s prescription at 06:12 a.m. There was no documented intradialytic assessment conducted by the registered nurse assigned to the patient during the patient’s hemodialysis treatment. Review of the registered nurse’s post treatment assessment revealed the following documentation: “pt tolerated treatment well, asymptomatic.” Treatment sheet dated 06/29/2024. Review of the patient#1’s treatment sheet dated 06/29/2024 revealed a prescription for blood flow rate of 400 mls/ minute and dialysate flow rate of 700 mls/ minute. Review of the patient’s treatment sheet dated 06/29/2024 revealed the patient blood flow rate was maintained at 350 mls/ minute from 08:01 a.m. to 10:31 a.m., instead of 400 mls/minute as ordered by the patient’s physician. There was no justification documented why the patient’s blood flow rate was not maintained at the prescribed rate of 400 mls/ minute. Review of the patient’s treatment sheet revealed documentation by the patient care technician assigned to the patient that the patient’s hemodialysis treatment was initiated by the patient care technician at 06:59 a.m. at a blood flow rate of 400 mls/ minute. At 8:01 a.m. the patient care technician decreased the patient’s blood flow rate to 350 mls/ minute and maintained it at 350 mls./ minute until 10:31 a.m. There was no documentation that the registered nurse assigned to the patient was informed of the decreased blood flow rate or that the registered nurse conducted an assessment on the patient after the patient’s blood flow rate was decreased by the patient care technician. On 07/16/2024 the Surveyor reviewed patient#1’s treatment sheets with the Facility’s Medical Clinical Support personnel who validated that the patient’s blood flow rate was not maintained at the prescribed rate. Patient #3 Review of the patient#3’s treatment sheet dated 07/11/2024 revealed a prescription for dialysate flow rate of 700 mls/ minute. Review of the patient’s treatment sheet dated 07/11/2024 revealed the patient’s dialysate flow rate was maintained at 500 mls/ minute instead of 700 mls/minute as ordered by the patient’s physician. Review of the patient’s treatment sheet revealed documentation by the patient care technician that the patient’s hemodialysis treatment was initiated by the patient care technician at 05:16 a.m. and continued at 8:55 a.m. Review of the treatment sheet revealed documentation by the registered nurse assigned to the patient that she verified the patient’s prescription at 06:54 a.m. Interview on 07/17/2024 at 9:57 a.m. with Registered Nurse (E ), the surveyor reviewed the patient’s record ( treatment sheet) with the Facility’s Registered Nurse. She states, “I missed it.””

“POC-MANAGE ANEMIA/H/H MEASURED Q MO CFR(s): 494.90(a)(4) The interdisciplinary team must provide the necessary care and services to achieve and sustain the clinically appropriate hemoglobin/hematocrit level. The patient’s hemoglobin/hematocrit must be measured at least monthly. The dialysis facility must conduct an evaluation of the patient’s anemia management needs. This Standard is not met as evidenced by: 10802 Based on observation, interview, and record review, the facility’s staff failed to administer patients’ medication based on physician’s orders in 2 of 7 sampled patients; Patient #s 3, 4 Findings: Patient #3 On 07/16/2024 at 8:27 a.m. Patient #3 was observed at station #9, hemodialysis machine #18. The patient was receiving hemodialysis treatment at a blood flow rate of 300 mls minute and dialysate flow rate of 700 mls/ minute via a right double lumen central venous catheter. Observation revealed a 10 ml syringe was observed attached to the medication administration port of the external blood line. The lumen of the medication port was filled with residual intravenous Venofer from previous administration of the medication to the patient. Review of the patient’s clinical record (treatment sheet ) dated 7/16/2024 revealed a prescription for Venofer 50 mg intravenously one time a week. Review of the patient’s treatment sheet revealed documentation that the medication was administered to the patient by the registered nurse at 06:38 a.m. Review of the patient’s clinical record revealed a physician’s order dated 2/9/2024 for Venofer 50 mg one time a week. Subsequent observation on 07/16/2024 at 10.44 a.m. revealed the patient’s hemodialysis treatment was discontinued and the patient left the unit while the Venofer remained in the lumen of the syringe. The Surveyor immediately notified and showed the facility’s acting administrator the Venofer in the medication administration lumen of the medication port. The Facility’s acting administrator states “ it’s a lot.” He then informed the Surveyor that the registered nurse who administered the medication at left for the day. Patient #4 On 07/16/2024 at 8:40 a.m. Patient #4 was observed at station #11, hemodialysis machine #3. The patient was receiving hemodialysis treatment at a blood flow rate of 300 mls minute and dialysate flow rate of 700 mls/ minute via a right double lumen central venous catheter. Observation revealed a 10 ml syringe was observed attached to the medication administration port of the external blood line. The lumen of the medication port was filled with residual intravenous Venofer from previous administration of the medication to the patient. Review of the patient’s clinical record (treatment sheet ) dated 7/16/2024 revealed a prescription for Venofer 50 mg intravenously one time a week. Review of the patient’s treatment sheet revealed documentation that the medication was administered to the patient by the registered nurse at 06:39 a.m. Review of the patient’s clinical record revealed a physician’s order dated 3/14/2023 for Venofer 50 mg one time a week. Subsequent observation on 07/16/2024 at 10.40 a.m. revealed the patient’s hemodialysis treatment was discontinued and the patient left the unit while the Venofer remained in the lumen of the syringe. The Surveyor immediately notified and showed the Facility’s Acting Administrator the Venofer left in the in the lumen of the medication Port. The Facility’s Acting Administrator informed the surveyor that the registered nurse who administered the medication at left for the day.”