Failure to Provide Individualized Dialysis Care and Monitoring
Penalty
Summary
A deficiency was identified in the care of a resident requiring dialysis services. The resident, who had multiple complex diagnoses including chronic kidney disease stage 4, dependence on renal dialysis, and a right arm fistula for dialysis access, did not have an individualized dialysis care plan. The care plan was generic and failed to specify the presence of a fistula or the specific care required for it. Physician orders did not include instructions to check for bruit and thrill in the fistula or to avoid taking blood pressure in the affected arm. Additionally, orders referenced a vascath, which the resident did not have, and included instructions for dressing care that were not consistent with the resident's actual needs. Staff interviews and record reviews revealed that nurses were signing off on dressing changes for the fistula site even though the resident reported and was observed not to have a dressing in place after dialysis. Nurses also confirmed that the care plan and orders were not updated to reflect the resident's current dialysis access and required monitoring. The lack of specific orders and individualized care planning resulted in the resident not receiving appropriate monitoring and care for the dialysis fistula, as required by professional standards and the resident's care needs.
Plan Of Correction
The facility will continue to ensure appropriate care is provided for residents receiving dialysis. Resident #26 continues to reside at the facility and receive dialysis services. On 3/26/2025, the licensed nurse reviewed orders with the PCP and updated orders to reflect current care needs and emergency care needs for his fistula. Resident #26's care plan was reviewed by the MDS nurse on 3/26/2025, to ensure we are addressing care needs for the fistula. Resident #26 is the facility's only dialysis patient at this time. No initial audit was needed to be completed at this time. On 4/14/2025, the Regional clinician reviewed facility practices for ensuring proper treatment for dialysis patients with the nursing IDT. This review included comprehensive care planning and revision, order sets to ensure the facility is meeting the needs of current dialysis patients, and reviewing dialysis notes to ensure awareness of treatment changes and orders. By 4/17/2025, licensed nurses will be reeducated regarding transcribing and monitoring for different types of dialysis access such as a fistula and/or vascath to ensure proper monitoring and proper documentation of a medical record to meet the needs of the patient. Weekly, for 2 weeks, or as directed by the QA committee, the DON or designee will audit residents receiving dialysis, ensuring proper orders are in place and care plans are updated to manage care needs. Findings will be corrected by reporting to the PCP and obtaining orders. Reeducation will be provided to licensed nursing staff. Negative findings will also be reported to the QA committee for review. The Administrator will ensure weekly completion of the audits. The DON is responsible for the ongoing compliance.