Deficient Dialysis Care and Monitoring in LTC Facility
Penalty
Summary
The facility failed to provide dialysis care consistent with professional standards for a resident with end-stage renal disease, muscle weakness, and diabetes. The resident had a clotted dialysis fistula and a tunneled catheter was placed for dialysis treatments. However, the facility did not have physician orders or a care plan for the tunneled catheter, nor did they monitor the catheter and dressing for potential complications. The facility also did not follow the vascular physician's recommendations regarding blood draws and needle pokes in the resident's right arm. The resident's care plan and physician orders were inconsistent and incomplete. The care plan did not include the presence of the tunneled catheter or interventions for its care, and the physician orders did not address monitoring the catheter. Additionally, the facility's records showed inconsistent documentation of the resident's 24-hour fluid restriction, with daily fluid intake totals ranging from zero to 2160 milliliters, which did not align with the ordered 1500 milliliters per day. Interviews with facility staff revealed a lack of awareness and understanding of the resident's dialysis care needs. Licensed Practical Nurses were unsure about the resident's fluid restriction and tunneled catheter, and the Dialysis Clinical Coordinator confirmed that the tunneled catheter was used for dialysis treatments. The Director of Nursing and Quality Assurance Nurse acknowledged that all dialysis access sites should be monitored, and the care plan should include the tunneled catheter, but there was no documented evidence of monitoring by the Infection Preventionist nurse.
Plan Of Correction
Plan of Correction: Approved March 19, 2025 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** F698 Corrective Action- To assure that residents requiring [MEDICAL TREATMENT] receive such services, consistent with professional standards of practice, the comprehensive person-centered care plan and the residents' goals and preferences. 1. Resident #36 orders were reviewed and updated for: 24-hour fluid restriction, and monitoring of the right chest tunneled catheter dressing. The left AV fistula orders were reviewed and discontinued and the interventions have been resolved. The care plan was reviewed and updated to include the right chest wall tunneled [MEDICAL TREATMENT] catheter, interventions for monitoring, and the 11/26/2024 vascular physician recommendations were reviewed by the provider and added to the care plan. The resident is scheduled to have a right arm fistula or graft completed on 4/7/2025. 2. All residents who receive [MEDICAL TREATMENT] treatment have potential to be affected by this practice. A list of all Residents on [MEDICAL TREATMENT] will be created and audited to assure fluid restrictions are monitored 24 hours a day, physician orders [REDACTED]. 3. To ensure this does not reoccur, the facility policy on [MEDICAL TREATMENT] will be reviewed and updated as needed. LPN and RN staff will be educated on said policy and written test to be provided to ensure competency. The Director of Nursing will oversee completion of these in-services. 4. To prevent future deficient practice, the Director of Nursing/Designee will perform audits of all [MEDICAL TREATMENT] residents each month for 3 months, and then as needed based on findings. Audits will include monitoring of any fluid restrictions, monitoring of physician orders [REDACTED]. The Director of Nursing will monitor this process and review the results monthly at QAPI meetings as needed. If continued improvement is needed the Committee may make further recommendations. The Director of Nursing will assume overall responsibility for correction of F698.