Deficiencies in Dialysis Communication and Care Planning
Penalty
Summary
The facility failed to ensure consistent communication between the dialysis provider and facility staff for four out of five residents requiring dialysis services. Specifically, the clinical records for these residents lacked complete communication forms, which are essential for maintaining continuity of care. For Resident R14, there were nine incomplete communication sheets and four missing sheets for December 2024. Similarly, Resident R22's records showed multiple instances of incomplete communication forms over several months. Resident R58 also had incomplete communication forms for several dates, and Resident R314's record was missing a communication sheet for a specific date. Additionally, the facility did not maintain accurate care plans for dialysis access sites for two residents. Resident R22's care plan failed to include monitoring instructions for the AV fistula, which is crucial for ensuring the fistula's functionality and preventing complications. Resident R314's care plan lacked a nursing plan of care for dialysis monitoring of the access device and communication with the dialysis center, only noting the days the resident attended dialysis. Interviews with facility staff, including registered nurses and the Director of Nursing, confirmed the deficiencies in maintaining complete dialysis communication forms and accurate care plans. These lapses in documentation and care planning are in violation of the facility's policy and state regulations, which require comprehensive care plans and consistent communication for residents undergoing dialysis.
Plan Of Correction
The facility cannot go backward and re-create documentation (i.e. blood pressures) from the past. Therefore, all RNs and LPNs will be educated by the Director of Nursing and/or designee on completely completing the dialysis communication log (example: vital signs, medical changes, status of access site including possible thrill and bruit, and nurse sign off) and having a care plan for the access site/fistula. The facility will audit all dialysis communication logs for all residents for completeness by both the facility and the dialysis center. Additionally, the care plans of the dialysis residents will be audited to ensure the access site/fistula is addressed. This will be completed weekly for three weeks and then three random dialysis residents weekly for three weeks. If a deficient practice is noted in the bottom half of the form completed by the dialysis center, it will be returned to them for completion. Any deficient practice will be immediately corrected. All data will be forwarded to the QAPI committee and the need for additional monitoring will be determined by the committee.