Usrc Premier

“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: 30124 Based on observation, record review ad interview, the facility’s registered nurse failed to ensure patient’s hemodialysis treatment is administered based on the physician’s order in 1 of 8 sampled patients: Patient #4. Policy Reviewed: Review on 01/25/2024 of the facility’s current policy with clinical specialist, staff ID #F titled “Initiation of Dialysis Treatment”, Policy # C-TI-0010, effective date 01/2020, Revision date 08/2020. Purpose: To provide guidance to prevent complications related to initiation of hemodialysis procedure. Policy: 7. Two staff members must verify and document on the flow sheet indicating the following items are correct prior to initiation of treatment: a. correct patient; b. All machine alarms and pressure holding tests passed and documented; c. Conductivity and pH are documented and within acceptable parameters; d. Correct prescription (dialyzer, concentrate, DFR, etc.) Procedure: 14. Prior to walking away from patient’s dialysis machine, verify all prescribed orders are followed. On 01/25/2024 at 12:40 PM patient #4 was observed at station 8 on the treatment floor of the facility. The patient was utilizing hemodialysis machine #13 for his hemodialysis treatment. The patient was receiving hemodialysis treatment at a blood flow rate of 400 mls/ minute and dialysate flow rate of 600 mls/ minute via a left upper arm vascular access. Observation along with registered nurse, staff ID #D revealed the patient was utilizing a 3.0 potassium 2.5 calcium dialysate for his hemodialysis treatment. The surveyor request staff ID #D open the panel on the hemodialysis machine to show the setting on the hemodialysis machine. Observation revealed the hemodialysis machine was set to deliver 2.0 potassium, 2.5 calcium dialysate and not the solution of 3.0 potassium, 2.5 calcium that was prescribed by the physician. Charge nurse staff ID #D immediately changed the hemodialysis machine to deliver the correct prescription. Interview on 1/25/2024 at 12:45 PM with staff ID #D confirmed he had verified the correct prescription, but only checked the gallon of acid that was on the machine and had not gone into the machine setting to verify the correct acid concentrate was selected. Review of the patient’s treatment sheet dated 01/25/2024 revealed documentation which indicated the patient’s hemodialysis treatment started at 09:53 AM.”

“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 record review and interview the facility’s Medical Director failed to ensure that employees followed the facility’s current policy and procedure in that pre-nursing assessment were not completed within the first hour of initiation of hemodialysis treatment for 4 of 8 selected patient records reviewed. (Patient ID#s 2, 3, 4, 5). Policy Reviewed: Review on 01/25/2024 of the facility’s current policy along with clinical services staff ID #F titled “Pre-Treatment Assessment of Patient”, Policy # C-PT-0010, effective date: 01/2020, Revision Date: 01/2020. Purpose: To provide pre dialysis treatment assessment and date collection guidelines. Policy: The patient will receive hemodialysis treatment and nursing care based on data collected and the pre dialysis nursing assessment. Pre dialysis nursing assessment will occur within the first hour of patient contact or per stricter state regulations. Review on 01/25/2024 of patient records along with staff ID #F identified the following: Patient ID #2’s hemodialysis record: 01/11/2024 hemodialysis treatment initiated at 11:00 AM Pre-assessment completed at 12:35 PM 01/16/2024 hemodialysis treatment initiated at 12:35 PM Pre-assessment completed at 14:32 PM 01/23/2024 hemodialysis treatment initiated at 10:50 AM Pre-assessment completed at 12:34 PM Patient ID #3’s hemodialysis record: 01/23/2024 hemodialysis treatment initiated at 10:32 AM Pre-assessment completed at 12:33 PM 01/16/2024 hemodialysis treatment initiated at 10:00 AM Pre-assessment completed at 13:57 PM 01/13/2024 hemodialysis treatment initiated at 10:04 AM Pre-assessment completed at 11:32 AM 01/11/2024 hemodialysis treatment initiated at 10:25 AM Pre-assessment completed at 13:53 PM Patient #4’s hemodialysis record: 01/23/2024 hemodialysis treatment initiated at 10:23 AM Pre-assessment completed at 11:40 AM 01/20/2024 hemodialysis treatment initiated at 09:49 AM Pre-assessment completed at 11:00 AM Patient #5’s hemodialysis record: 01/23/2024 hemodialysis treatment initiated at 10:31 AM Pre-assessment completed at 12:30 PM 01/16/2024 hemodialysis treatment initiated at 13:37 PM Pre-assessment completed at 17:57 PM 01/11/2024 hemodialysis treatment initiated at 10:46 PM Pre-assessment completed at 13:46 PM Interview on 01/25/2023 at 15:30 PM with clinical services staff ID #F confirmed the initial nursing assessments were not completed within the first hour of dialysis for the above findings.”