Failure to Provide Required Dialysis Assessment and Care
Penalty
Summary
The facility failed to provide necessary dialysis assessment, care, and services for a resident diagnosed with end-stage renal disease who was dependent on dialysis. The resident's baseline care plan did not include documentation of dialysis services or instructions for dialysis care. The electronic medical record lacked orders related to dialysis care, and there was no evidence of completed dialysis communication forms before or after treatments. Progress notes inconsistently documented the resident's dialysis schedule and did not consistently record whether the resident attended dialysis, returned from dialysis, or received assessments related to dialysis. On several occasions, there was no documentation of pre- or post-dialysis assessments, vital signs, weights, or fistula assessments. Interviews with staff revealed that the facility missed entering dialysis orders and did not perform required pre- and post-dialysis assessments. The resident reported that nurses did not obtain vital signs, pre-dialysis weight, or assess the dialysis site before he left for dialysis, and sometimes he left before breakfast. Staff confirmed that the resident's representative transported him to dialysis, which contributed to the missed assessments. The facility's hemodialysis policy required coordination and collaboration with the dialysis center to meet the resident's needs, but this was not followed in practice.