Failure to Update Care Plan for Dialysis Treatment
Penalty
Summary
The facility failed to update the care plan for a resident who was undergoing dialysis treatment. The resident, who was cognitively intact and required assistance for daily care needs, had a hemodialysis catheter in place as per the care plan dated August 7, 2023. However, nursing notes indicated that the resident had a left upper arm fistula placed on November 6, 2023, and the hemodialysis catheter was removed on May 7, 2024. Despite these significant changes in the resident's dialysis treatment, the care plan was not revised to reflect the removal of the catheter and the use of the fistula. Interviews with the resident and the Director of Nursing confirmed that the care plan should have been updated to reflect these changes. The resident himself confirmed the removal of the catheter and the presence of the fistula during an interview on April 15, 2024. The Director of Nursing acknowledged that the care plan was not updated as required, which was a failure to comply with the facility's policy and regulatory requirements for care plan revisions.
Plan Of Correction
1. On April 15, 2025 resident 37 care plan was updated to reflect discharge of hemodialysis catheter. No other residents were identified as having this issue. 2. Facility updated change in condition checklist to include discharged orders. Updates to care plan will be verified at morning Interdisciplinary team meeting as change in condition checklist is completed. 3. Facility will complete on the spot education with registered nurses, licensed practical nurses and the interdisciplinary team regarding requirements for timing and revisions of care plan based on §483.21(b)(2)(i)-(iii) and need to update and reflect current care needs. Education will be completed by 5/29/2025. 4. Director of Nursing or designee will perform weekly audits that care plan updates have been made in relation to discharge orders. Audits will be performed weekly for 1 month then monthly for 2 consecutive months. 5. Results of audits will be reported at the Quality Assurance and Performance Improvement meeting.