Failure to Provide Safe and Appropriate Dialysis Care and Coordination
Penalty
Summary
The facility failed to provide dialysis services consistent with professional standards for a resident with chronic kidney disease stage 5 and dependence on renal dialysis. The facility did not properly coordinate communication with the dialysis center, as evidenced by incomplete Dialysis Communication Records (DCRs) on multiple dates. There was no documentation in the nurse's notes indicating that licensed nurses contacted the dialysis clinic to obtain special instructions or information about the resident's pre- and post-dialysis condition, weight, or other relevant details. Additionally, the facility's own policy required exchange of information and completion of communication forms before and after dialysis, which was not followed. The resident's care plan was not person-centered and included interventions inappropriate for the type of dialysis access in use. Specifically, the care plan referenced monitoring for thrill and bruit, which are not applicable to a chest permacath, the access device the resident had. The assistant director of nursing confirmed that the care plan did not reflect the resident's actual needs and status, and that it would need to be revised to be accurate and individualized. Staff interviews revealed that nurses had not received current training on caring for residents receiving dialysis, and there was no emergency dialysis kit available in the unit, medication room, medication cart, or crash cart. This lack of training and equipment further demonstrated the facility's failure to meet the needs of residents requiring dialysis care, as required by facility policy and professional standards.