Failure to Administer Phosphate Binders with Meals for Dialysis Residents
Penalty
Summary
The facility failed to administer phosphate binder medications as prescribed for five residents receiving dialysis. These medications, including Renvela, Velphoro, Calcium Acetate, and Auryxia, are required to be given with meals to effectively control phosphorus levels in patients with end-stage renal disease or chronic kidney disease. Medication Administration Records (MARs) and staff interviews revealed that these medications were routinely administered during scheduled med passes rather than with meals, and in several cases, after residents had already left the facility for dialysis appointments, resulting in missed or improperly timed doses. For example, one resident with end-stage renal disease on hemodialysis had orders for Renvela to be given before meals, but the MAR showed administration times that did not coincide with meal times and occurred after the resident had departed for dialysis. Similar patterns were observed for other residents, including those prescribed Velphoro, Calcium Acetate, and Auryxia, with MAR entries indicating administration at times not aligned with meals or the residents' presence in the facility. Staff interviews, including those with the Unit Manager and DON, confirmed that medications were not being administered as prescribed with food, but rather during routine medication passes. The residents affected had complex medical histories, including chronic heart failure, diabetes, hypertension, anemia, and other comorbidities, and were all dependent on hemodialysis. The failure to administer phosphate binders as ordered was consistent across all five residents reviewed, regardless of their individual dialysis schedules or dietary accommodations. The deficiency was identified through observation, record review, and staff interviews, all of which confirmed the deviation from prescribed medication administration protocols.