Failure to Monitor and Assess Dialysis Access Site and Treatments
Penalty
Summary
The facility failed to provide safe and appropriate dialysis care and services for a resident with end-stage renal disease who was dependent on hemodialysis and had an arteriovenous (AV) fistula in the right arm. Facility policy required staff to assess and document the condition of the dialysis access site every shift, including checking for signs of infection, monitoring the color and temperature of the fingers, presence of radial pulse, and assessing for thrill and bruit at the fistula site. Additionally, staff were required to complete pre- and post-dialysis assessments and document these in the resident's record. However, review of the resident's medical records, including the Medication Administration Record (MAR) and Treatment Administration Record (TAR), showed no evidence that these assessments or monitoring were performed or documented. Interviews with the resident, an LPN, and the Director of Nursing confirmed that staff did not routinely check the resident's fistula or perform assessments before or after dialysis treatments. The resident reported that nurses did not check the fistula or monitor him after returning from dialysis. The LPN stated that no assessment or vital signs were taken after dialysis unless required for medication administration. The DON acknowledged that pre- and post-dialysis assessments were not being completed and that the clinical record lacked documentation of required monitoring and assessments for the dialysis access site.