Failure to Provide Required Dialysis Assessment and Care
Penalty
Summary
The facility failed to provide necessary dialysis assessment, care, and services for a resident diagnosed with end-stage renal disease who was dependent on dialysis. The resident's care plan and physician orders required staff to coordinate with the dialysis center, monitor and maintain the central venous catheter (CVC) site, and complete pre- and post-dialysis assessments. However, there were multiple documented instances where pre/post dialysis evaluations and dialysis communication forms were not completed as required. Additionally, the resident's electronic medical record did not show evidence that the physician or dialysis center was notified when the CVC dressing was found soiled. Observation revealed that the resident's CVC dressing was soiled with blood, not tightly secured, and the chest area showed redness, yet there was no documentation of appropriate follow-up or notification. Interviews with nursing staff indicated that post-dialysis assessments were not routinely performed, and the expectation to monitor the catheter site and maintain cleanliness was not consistently met. The facility's own hemodialysis policy required monitoring and documentation of the access site after treatment, which was not followed in this case.