Failure to Develop Care Plan for Dialysis Refusals
Penalty
Summary
The facility failed to develop and implement a comprehensive care plan addressing a resident's dialysis needs, specifically neglecting to include the resident's repeated refusals of dialysis treatments. The resident, who was admitted with diagnoses including Type 2 diabetes mellitus with diabetic chronic kidney disease stage 5, was receiving dialysis three times per week. Documentation showed that the resident had little to no cognitive impairment and had a dialysis access site that required monitoring. Despite multiple documented refusals of dialysis, including four refusals noted on one occasion, the care plan did not reflect these refusals or provide goals and interventions related to dialysis or the refusals. Staff interviews confirmed that a care plan should have been in place for the resident's dialysis and for addressing treatment refusals, but none was found. The last care plan conference occurred prior to the documented refusals, and the care plan lacked any focus on dialysis or interventions for refusals. The facility's policy required that care plans be updated to reflect significant changes in condition or needs, but this was not done for the resident in question.