Lack of Physician Orders and Monitoring for Dialysis Residents
Penalty
Summary
The facility failed to provide appropriate dialysis care and services for two residents receiving hemodialysis. Record reviews showed that neither resident had physician orders for dialysis care, services, or treatments documented in their medical records. For one resident, although there was an order to receive dialysis on specific days, the order did not specify the dialysis location, transportation times, or instructions regarding holding medications during dialysis. The other resident also lacked physician orders for dialysis services, including monitoring of the fistula site for bruit and thrill, signs of infection, bleeding, pressure bandage, swelling, and details about the dialysis schedule and location. There were no orders to hold medications while at the dialysis center for either resident. Interviews with an LPN and the Director of Nursing confirmed that staff are expected to monitor and assess dialysis access sites before and after treatments and that physician orders should be present in the medical record for such care. Both staff members acknowledged the absence of these required orders for the two residents. A review of facility policy indicated that staff are responsible for verifying physician orders, measuring vital signs, and observing shunt sites before and after dialysis, but these actions were not supported by documented orders in the residents' records.