Failure to Revise Care Plan and Provide Intervention for Dialysis Access Site
Penalty
Summary
The facility failed to revise the care plan for one resident receiving dialysis and did not provide an intervention for the resident's dialysis access site after returning from dialysis with a pressure dressing in place. The resident, who has a history of end stage renal disease, hypertensive heart and chronic kidney disease, diabetes, dementia, and dependence on renal dialysis, was observed with a dressing on his upper left arm after returning from dialysis. The resident reported that the dressing was applied at the dialysis center and that sometimes nurses at the facility remove it and apply Band-Aids if there is still bleeding. Review of the resident's care plan showed it included monitoring for complications from hemodialysis, avoiding blood draws or blood pressure measurements on the arm with the arteriovenous fistula, encouraging attendance at dialysis appointments, and monitoring for signs of infection or renal insufficiency. However, the care plan did not include specific interventions for the care of the dialysis access site or removal of the pressure dressing after dialysis. Interviews with nursing staff revealed inconsistent practices regarding who is responsible for removing the pressure dressing and when it should be removed. One nurse stated that the night shift is responsible, while another indicated that the dressing is usually removed within two hours of the resident's return from dialysis, but confirmed it was not removed as expected. The Director of Nursing confirmed that there was no established protocol for the removal of the pressure dressing prior to contacting the dialysis center for guidance. The lack of a clear intervention in the care plan and inconsistent staff practices resulted in the resident retaining the pressure dressing for an extended period after returning from dialysis, without appropriate assessment or intervention documented in the care plan.