Failure to Perform and Document Required Dialysis Access Assessments
Penalty
Summary
The facility failed to provide consistent professional dialysis care for a resident who required such services. Specifically, the resident, who had a right chest catheter and a left lower arm arteriovenous fistula (AVF) for dialysis access, did not receive required pre- and post-dialysis assessments of the AVF site. Review of the resident's dialysis binder revealed that, over a period of approximately two months, there were 18 instances where no pre-dialysis assessment and 19 instances where no post-dialysis assessment of the AVF for thrill and bruit were documented. Additionally, the electronic medication administration record (eMAR) showed that licensed nurses incorrectly documented the presence of bruit and thrill at the right chest catheter site, which is not clinically appropriate as dialysis catheters do not have these characteristics. During interviews and record reviews, the DON confirmed that the pre- and post-dialysis forms and monitoring orders in the eMAR were incomplete, inaccurate, and erroneous. The facility's own policy required that shunt sites be checked for patency every shift and that the condition of the access site and dressing be documented both before and after dialysis. The documentation practices observed did not meet these requirements, resulting in incomplete and inaccurate medical records for the resident.