Failure to Perform and Document Daily Dialysis Fistula Checks
Penalty
Summary
The facility failed to provide daily monitoring and documentation of a dialysis fistula site for a resident with end stage renal disease who required hemodialysis three times per week. The resident's care plan and physician's orders specified that the dialysis access site, located in the left bicep, should be assessed, observed, and documented for care and complications. However, a review of the interdisciplinary notes and treatment/medication administration records revealed no documentation of daily or shift-based fistula site assessments. Interviews with nursing staff confirmed that the fistula access site was only monitored on dialysis days, and no assessments were completed on non-dialysis days. The facility's own policy required that the dialysis access site be checked before and after dialysis treatments and every shift for patency by auscultation for a bruit and palpation of a thrill. This lack of daily monitoring and documentation constituted a failure to follow both professional standards of practice and the facility's policy for residents receiving hemodialysis.