Failure to Provide Safe and Appropriate Dialysis Care and Documentation
Penalty
Summary
The facility failed to provide appropriate dialysis care for two residents with end-stage renal disease (ESRD) who required dialysis services. For one resident, the dialysis communication records, which serve as a communication tool between the dialysis center and the facility, contained multiple blank entries for the dialysis access site assessment on several dates. Both the LVN and the DON confirmed that these records should have been fully completed prior to the resident going to the dialysis center, as per facility policy. For another resident, the facility did not ensure that an emergency dialysis kit was kept at the bedside, as required by physician's order and facility policy. During an interview and observation, the LVN was unable to locate the emergency dialysis kit at the resident's bedside, despite acknowledging that it should be present even if the resident was no longer receiving dialysis treatments but still had a dialysis access in place. The DON also confirmed that the kit should have been readily available for any resident with a dialysis access. Additionally, the facility failed to ensure that licensed nurses assessed and documented the resident's dialysis access site and maintained a transparent dressing over the site. Medical record review showed no documentation of assessment of the dialysis catheter, and the resident's care plan did not address the care of the dialysis catheter. Observation confirmed that the resident's dialysis access site was not covered with a transparent dressing, and the DON was unable to find documentation of the last dressing change. These failures were verified by both the LVN and the DON during interviews and record reviews.