Failure to Consistently Assess and Document Dialysis Access Site
Penalty
Summary
A deficiency was identified when the facility failed to ensure that a resident requiring dialysis had their dialysis access site assessed and monitored as ordered. The resident, who had diagnoses including stroke, congestive heart failure, and dependence on renal dialysis, had a physician's order for their arteriovenous (AV) fistula to be assessed for patency, audible bruit, and palpable thrill every shift. The care plan also required monitoring and documentation of signs and symptoms of infection at the access site. However, review of the Treatment Administration Records (TAR) for January, February, and March revealed multiple shifts where there was no documentation that the AV fistula was assessed as required. During an interview, the Director of Nursing confirmed that the resident's fistula should have been monitored every shift, in accordance with the facility's hemodialysis policy. The policy specified that the dialysis access site should be checked before and after dialysis treatments and every shift for patency by auscultation and palpation. The lack of documentation on several shifts indicated that the required assessments were not consistently performed or recorded, resulting in noncompliance with physician orders and facility policy.