Fresenius Medical Care Midwest Ryan Road

“POC-MANAGE VOLUME STATUS CFR(s): 494.90(a)(1) The plan of care must address, but not be limited to, the following: (1) Dose of dialysis. The interdisciplinary team must provide the necessary care and services to manage the patient’s volume status; This Standard is not met as evidenced by: 29972 Based on record review and interview, staff failed to ensure that the nursing assessments and interventions address fluid management needs pre and post dialysis treatment to ensure safe and effective dialysis in 3 of 10 records reviewed (Patients (Pt) #1, #6, #9), in a total sample of 10 medical records reviewed. Findings include: Review of policy and procedure #45265 titled, “Nursing Supervision and Delegation” Version 6 Published 11/06/2023 revealed: - “Prior to discharge the Registered Nurse (RN) must review the treatment record to confirm...Whether the patient is achieving dry weight and identify reason for patient not achieving dry...” - “The Team Leader/Charge Nurse will use their clinical judgement based on individual patient needs to determine if any clinical interventions are necessary.” - RN should address “Any post treatment weight with a variance from the estimated dry weight of 1.0 kg.” - “Document all findings in the patient’s medical record.” Review of policy and procedure #45284 titled, “Patient Assessment and Monitoring” Version 4 Published 05/01/2023 revealed: - “Monitor UF (Ultrafiltration Rate). Note: Ultrafiltration rates greater than 13 ml (milliliters)/kg (Kilograms)/hr (hour) should be avoided if possible, by providing adequate prescribed dialysis duration and scheduling of additional treatments if medically necessary.” Fluid Assessments: Review of Pt #1’s treatment sheets revealed the following: - On 04/04/2025: Pt #1’s Estimated Dry Weight (EDW) was 45.0 kg (kilograms) and the post-treatment weight was 49.5 kg (4.5 kg above the EDW). There was no documentation of nursing interventions and notifying the physician to address Pt #1’s post weight being >1 kg above the EDW. - On 04/04/2025: Pt #1’s fluid removal goal was set for 3.0 kg, this was greater than 13 ml/kg/hr (13 ml x 51.0 kg--pre-weight x 4 hours = 2.65 kg); there was no documentation of the nurse recognizing and addressing Pt #1’s UF rate being greater than 13 ml/kg/hr and obtaining a physician order. - On 04/11/2025: Pt #1’s EDW was 45.0 kg and the post-treatment weight was 53.8 kg (8.8 kg above the EDW). There was no documentation of nursing interventions and notifying the physician to address Pt #1’s post weight being >1 kg above the EDW. - On 04/11/2025: Pt #1’s fluid removal goal was set for 3.0 kg, this was greater than 13 ml/kg/hr (13 ml x 55.6 kg x 3 hours = 2.16 kg); there was no documentation of the nurse recognizing and addressing Pt #1’s UF rate being greater than 13 ml/kg/hr and obtaining a physician order. - On 04/14/2025: Pt #1’s EDW was 45.0 kg and the post-treatment weight was 57.7 kg (12.7 kg above the EDW). There was no documentation of nursing interventions and notifying the physician to address Pt #1’s post weight being >1 kg above the EDW. - On 04/14/2025: Pt #1’s fluid removal goal was set for 3.5 kg, this was greater than 13 ml/kg/hr (13 ml x 60.8 kg x 3 hours = 2.37 kg); there was no documentation of the nurse recognizing and addressing Pt #1’s UF rate being greater than 13 ml/kg/hr and obtaining a physician order. Review of Pt #6’s treatment sheets revealed the following: - On 04/30/2025: Pt #6’s EDW was 71.7 kg and the post-treatment weight was 75.0 kg (3.3 kg above the EDW). There was no documentation of nursing interventions and notifying the physician to address Pt #6’s post weight being >1 kg above the EDW. - On 05/02/2025: Pt #6’s EDW was 71.7 kg and the post-treatment weight was 73.3 kg (1.6 kg above the EDW). There was no documentation of nursing interventions and notifying the physician to address Pt #6’s post weight being >1 kg above the EDW. - On 05/05/2025: Pt #6’s EDW was 71.7 kg and the post-treatment weight was 73.8 kg (2.1 kg above the EDW). There was no documentation of nursing interventions and notifying the physician to address Pt #6’s post weight being >1 kg above the EDW. Review of Pt #9’s treatment sheets revealed the following: - On 05/06/2025: Pt #9’s EDW was 67.0 kg and the post-treatment weight was 70.8 kg (3.8 kg above the EDW). There was no documentation of nursing interventions and notifying the physician to address Pt #9’s post weight being >1 kg above the EDW. - On 05/03/2025: Pt #9’s EDW was 67.0 kg and the post-treatment weight was 68.7 kg (1.7 kg above the EDW). There was no documentation of nursing interventions and notifying the physician to address Pt #9’s post weight being >1 kg above the EDW. - On 05/01/2025: Pt #9’s EDW was 67.0 kg and the post-treatment weight was 69.0 kg (2.0 kg above the EDW). There was no documentation of nursing interventions and notifying the physician to address Pt #9’s post weight being >1 kg above the EDW. During interview with Director of Operations (DO) C on 05/08/2025 beginning at 11:20 AM, while discussing medical record findings, DO C confirmed the findings and stated that the nurse should notify the provider and document the nursing interventions when patients have a post weight 1.0 kg greater than their ordered EDW. DO C stated that staff should not set a patient’s fluid removal goal for more than 13 ml/kg/hr without consulting with a physician and obtaining a “special attention order to do so.””

“POC-ACHIEVE ADEQUATE CLEARANCE CFR(s): 494.90(a)(1) Achieve and sustain the prescribed dose of dialysis to meet a hemodialysis Kt/V of at least 1.2 and a peritoneal dialysis weekly Kt/V of at least 1.7 or meet an alternative equivalent professionally-accepted clinical practice standard for adequacy of dialysis. This Standard is not met as evidenced by: 29972 Based on record review and interview the facility staff failed to recognize and address shortened treatments as per policy to ensure adequate dialysis in 1 of 10 medical records reviewed (Patient (Pt) #1), in a total sample of 10 medical records reviewed. Findings Include: Review of policy and procedure #45263 titled, “Early Termination...” Version 3 published 11/07/2022 revealed: - “Patient requesting early termination of a treatment...will be referred to the supervising registered nurse.” - “The registered nurse (RN) will evaluate the patient and discuss with the patient their reason for requesting to terminate their treatment earlier than prescribed.” - “The RN who evaluates the patient must document the rationale for early termination and reinforce the consequences of not receiving the entire prescribed treatment.” - “The RN is responsible to notify the physician, and document on the “AMA” , or Against Medical Advice form.” Review of Pt #1’s Treatment Sheets revealed the following: -03/31/2025: Pt #1’s dialysis treatment time was ordered for 4 hours. Treatment started at 11:44 AM and ended at 2:45 PM, 59 minutes short. There was no documentation of an AMA form completed as per policy. -04/02/2025: Pt #1’s dialysis treatment time was ordered for 4 hours. Treatment started at 11:46 AM and ended at 2:52 PM, 54 minutes short. There was no documentation of an AMA form completed as per policy. -04/04/2025: Pt #1’s dialysis treatment time was ordered for 4 hours. Treatment started at 11:43 AM and ended at 2:40 PM, 63 minutes short. There was no documentation of an AMA form completed as per policy. During interview with Director of Operations (DO) C on 05/08/2025 beginning at 11:20 AM, while discussing medical record findings, DO C confirmed the findings and stated that staff should be documenting in the medical record the reason patient’s time was shortened, nursing interventions addressing shortened treatment, and notifying the physician. DO C confirmed there were no AMA forms completed for the above dates.”