Fkc Northside 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: 48020 Based on observation, record review and interview, the facility’s licensed nurses and direct care staff failed to administer patients’ hemodialysis treatments based on physicians’ orders in 2 of 16 sampled and closed patients: Patient #s 7 and 5 Findings: Review of the facility’s current Policy and Procedure on Nursing Supervision and Delegation; Policy #45265, published 11/06/2023 directs staff as follows: Policy The registered nurse must evaluate each patient preferably within an hour or according to state requirements to: ... “ Review accuracy and completeness of treatment and patient data “ Review patient treatment prescription and equipment parameters to verify correct settings, and if dialysis prescription is being followed. Patient #7 On 12/04/2024 at 12:33 p.m. Patient #7 was observed on the treatment floor of the facility at station #8 machine #7. The patient was receiving hemodialysis treatment at a blood flow rate of 400 mL/min and dialysate flow rate of 800 mL/min. The patient was utilizing an Optiflux 180 non reuse dialyzer via a left central venous catheter. Review of the physician’s order dated 11/25/2024 revealed the prescribed hemodialysis treatment time of four hours. Treatment sheet review: Review of the patient’s treatment sheet dated 11/26/2024 revealed documentation which indicated the “Hours On” the hemodialysis treatment was 3:47 instead of the prescribed 4:00 hours. There was no documented justification why the patient did not receive the hemodialysis treatment at the prescribed time nor whether the patient signed and early termination Against Medical Advice form. Review of the patient’s treatment sheet dated 11/26/2024 revealed documentation which indicated the “Hours On” the hemodialysis treatment was 3:46 instead of the prescribed 4:00 hours. There was no documented justification why the patient did not receive the hemodialysis treatment at the prescribed time nor whether the patient signed and early termination Against Medical Advice form. Patient #5 On 12/04/2024 at 12:37 p.m. Patient #5 was observed on the treatment floor of the facility at station #10 machine 1. The patient was receiving hemodialysis treatment at a blood flow rate of 400 mL/min and dialysate flow rate of 800 mL/min. The patient was utilizing an Optiflux 180 non reuse dialyzer via a left lower arm vascular access. Review of the physician’s order dated 12/02/2024 revealed the prescribed blood flow rate of 400 mL/min. Treatment sheet review: Review of the patient’s treatment sheet dated 11/29/2024 revealed documentation which indicated the patient was prescribed a blood flow rate of 400 mL/min but received hemodialysis treatment at a blood flow rate of 350 mL/min from 10:09 a.m. - 13:37 p.m. There was no justification documented for the blood flow rate of 350 mL/min. The physician’s order on the treatment sheet revealed a blood flow rate of 400 mL/min. Interview on 12/04/2024 at 2:13 p.m. with the facility’s Clinical Manager (E) confirmed Patient #s 7 and 5 did not receive their hemodialysis treatments as prescribed for the dates in question.”

“POC-PTS SEEN BY MED STAFF 1X/MO CFR(s): 494.90(b)(4) The dialysis facility must ensure that all dialysis patients are seen by a physician, nurse practitioner, clinical nurse specialist or physician’s assistant providing ESRD care at least monthly, as evidenced by a monthly progress note placed in the medical record, and periodically while the hemodialysis patient is receiving in-facility dialysis. This Standard is not met as evidenced by: 48020 Based on observation, interview and record review the facility failed to ensure patient’s nephrologist round and assess patient’s monthly in 5 of 16 sampled patients: Patient #s 4, 6, 7, 8 and 5 Findings: Patient #4 On 12/04/2024 at 12:27 p.m. Patient #4 was observed on the treatment floor of the facility at station #1 machine #10. The patient was receiving hemodialysis treatment at a blood flow rate of 400 mL/min and dialysate flow rate of 800 mL/min. The patient was utilizing an Optiflux 180 non reuse dialyzer via a left lower arm vascular access. Review of the patient’s clinical record revealed the patient was admitted to the facility on 01/21/2021 with diagnoses of end stage renal disease and diabetes on oral medications, on in-center hemodialysis three times weekly. Review of the patient’s Physician Documentation Summary dated 06/01/2024 - 12/04/2024 revealed the most recent physician progress note was documented on 11/22/2024. There was a physician progress note documented for 06/12/2024, 08/07/2024, 08/23/2024, 09/18/2024, 09/30/2024 and 11/20/2024. There was no documented physician note for July 2024 and October 2024. Patient #6 On 12/04/2024 at 12:31 p.m. Patient #6 was observed on the treatment floor of the facility at station #2 machine #15. The patient was receiving hemodialysis treatment at a blood flow rate of 400 mL/min and dialysate flow rate of 800 mL/min. The patient was utilizing an Optiflux 180 non reuse dialyzer via a left upper arm vascular access. Review of the patient’s clinical record revealed the patient was admitted to the facility on 11/30/2023 with diagnoses of end stage renal disease, congestive heart failure, cerebrovascular disease, cerebrovascular accident, transient ischemic attack, history of hypertension and diabetes currently on insulin, on in-center hemodialysis three times weekly. Review of the patient’s Physician Documentation Summary dated 06/01/2024 - 12/04/2024 revealed the most recent physician progress note was documented on 11/22/2024. There was a physician progress note documented for 06/12/2024, 08/07/2024, 08/22/2024, 08/23/2024, 09/18/2024, 09/20/2024 and 09/30/2024. There was no documented physician note for July 2024 and October 2024. Patient #7 On 12/04/2024 at 12:33 p.m. Patient #7 was observed on the treatment floor of the facility at station #8 machine #7. The patient was receiving hemodialysis treatment at a blood flow rate of 400 mL/min and dialysate flow rate of 800 mL/min. The patient was utilizing an Optiflux 180 non reuse dialyzer via a left central venous catheter. Review of the patient’s clinical record revealed the patient was admitted to the facility on 02/12/2024 with diagnoses of end stage renal disease, congestive heart failure, history of hypertension and diabetes without medications, on in-center hemodialysis three times weekly. Review of the patient’s Physician Documentation Summary dated 06/01/2024 - 12/04/2024 revealed the most recent physician progress note was documented on 11/22/2024. There was a physician progress note documented for 06/12/2024, 08/07/2024, 08/22/2024, 08/23/2024, 09/18/2024, 09/20/2024 and 09/30/2024. There was no documented physician note for July 2024 and October 2024. Patient #8 On 12/04/2024 at 12:35 p.m. Patient #8 was observed on the treatment floor of the facility at station #9 machine #9. The patient was receiving hemodialysis treatment at a blood flow rate of 500 mL/min and dialysate flow rate of 800 mL/min. The patient was utilizing an Optiflux 200 non reuse dialyzer via a left lower arm vascular access. Review of the patient’s clinical record revealed the patient was admitted to the facility on 10/05/2019 with diagnoses of end stage renal disease, and history of hypertension, on in-center hemodialysis three times weekly. Review of the patient’s Physician Documentation Summary dated 06/01/2024 - 12/04/2024 revealed the most recent physician progress note was documented on 11/24/2024. There was a physician progress note documented for 06/12/2024, 08/07/2024, 08/23/2024, 09/18/2024, 09/20/2024 and 09/30/2024. There was no documented physician note for July 2024 and October 2024. Patient #5 On 12/04/2024 at 12:37 p.m. Patient #5 was observed on the treatment floor of the facility at station #10 machine 1. The patient was receiving hemodialysis treatment at a blood flow rate of 400 mL/min and dialysate flow rate of 800 mL/min. The patient was utilizing an Optiflux 180 non reuse dialyzer via a left lower arm vascular access. Review of the patient’s clinical record revealed the patient was admitted to the facility on 04/17/2024 with diagnoses of end stage renal disease, and history of hypertension, on in-center hemodialysis three times weekly. Review of the patient’s Physician Documentation Summary dated 06/01/2024 - 12/04/2024 revealed the most recent physician progress note was documented on 11/22/2024. There was a physician progress note documented for 06/12/2024, 08/07/2024, 08/23/2024, 09/18/2024 and 09/30/2024. There was no documented physician note for July 2024 and October 2024. Interview with Clinical Manager (E) on 12/04/2024 at 3:30 p.m. confirmed there was one physician who did not document progress notes for the above dates in question.”

“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: 48020 Based on observation, record review and interview: the facility’s registered nurses failed to conduct assessments when patients experienced a change in condition during hemodialysis treatment in 3 of 16 sampled patients: Patient #s 1, 6, 11 Findings: Review of the facility’s current Policy and Procedure on Patient Assessment and Monitoring; Policy # 45284, published 05/01/2023 directs staff as follows: 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. o 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. Reassessment of edema: Patient #1 On 12/04/2024 at 7:50 a.m. Patient #1 was observed on the treatment floor of the facility at station #5 machine #14. The patient was receiving hemodialysis treatment at a blood flow rate of 400 mL/min and dialysate flow rate of 800 mL/min. The patient was utilizing an Optiflux 180 non reuse dialyzer via a left upper arm vascular access. Review of the patient’s clinical record on 12/04/2024 revealed the following: Treatment sheet review: Review of treatment sheet dated 11/22/2024 revealed the following documentation: 05:55 a.m.: registered nurse documented the pretreatment assessment which revealed “Symptoms Lower Leg - Severity: 1+: 2 mm or less, disappears rapidly Ankle - Severity: 1+: 2 mm or less, disappears rapidly Edema Lower Leg - Location: Bilateral Edema Ankle - Location: Bilateral” 11:17 a.m.: registered nurse documented the post treatment assessment which revealed “General Survey: Alert, Oriented, Wheelchair General Overview: No Complaint Physical Exam: Speech Clear Notes: 2.4kg above EDW. Tolerated tx well. Alert and stable. Verbal education on salt and fluid intake. Pt expressed verbal understanding.” The registered nurse did not document a reassessment of edema found during the pretreatment assessment. Review of Review of treatment sheet dated 11/24/2024 revealed the registered nursed did not document a reassessment of edema found during the pretreatment assessment. Patient #6 On 12/04/2024 at 12:31 p.m. Patient #6 was observed on the treatment floor of the facility at station #2 machine #15. The patient was receiving hemodialysis treatment at a blood flow rate of 400 mL/min and dialysate flow rate of 800 mL/min. The patient was utilizing an Optiflux 180 non reuse dialyzer via a left upper arm vascular access. Review of the patient’s clinical record on 12/05/2024 revealed the following: Treatment sheet review: Review of treatment sheet dated 12/02/2024 revealed the following documentation: 10:23 a.m.: registered nurse documented the pretreatment assessment which revealed “Symptoms Ankle - Severity: 1+: 2 mm or less, disappears rapidly Lower Leg - Severity: 1+: 2 mm or less, disappears rapidly Edema Lower Leg - Location: Bilateral Edema Ankle - Location: Bilateral” 15:04 p.m.: registered nurse documented the post treatment assessment which revealed “General Survey: Alert, Oriented Ambulation Status: Ambulates w/assistive device General Overview: No Complaint Physical Exam: Calm, Pleasant Notes: 0.3kg below EDW. Tolerated tx well. Alert and stable.” The registered nurse did not document a reassessment of edema found during the pretreatment assessment. Reassessment of breath sounds: Patient #11 Review of the patient’s clinical record on 12/05/2024 revealed the patient was admitted to the facility on 03/26/2019 with diagnoses of end stage renal disease, history of hypertension and diabetes currently on insulin, on in-center hemodialysis three times weekly. Treatment sheet review: Review of treatment sheet dated 07/17/2024 revealed the following documentation: 18:13 p.m.: registered nurse documented the pretreatment assessment which revealed “Symptoms: Shortness of Breath Lungs: Decreased breath sounds Lungs - Sound Location: Bilateral” 21:16 p.m.: registered nurse documented the post treatment assessment which revealed “General Survey: Alert, Oriented Ambulation Status: Ambulates w/assistive device General Overview: No Complaint Notes: Pt request to leave early because she must be here tomorrow early; v/s acceptable; MD informed. No complaints at d/c.” The registered nurse did not document a reassessment of shortness of breath and decreased breath sounds found during the pretreatment assessment. Interview with Clinical Manager (G) on 12/05/2024 at 2:15 p.m. confirmed the reassessments of edema and lung sounds were not completed post treatment by the registered nurses for the patients above.”