Failure to Monitor Dialysis Shunt for Bruit and Thrill
Penalty
Summary
The facility failed to ensure appropriate post-dialysis assessment and monitoring for a resident with end-stage renal disease who received hemodialysis outside the facility. The resident's care plan required daily assessment of the dialysis shunt, including checking for a palpable thrill and auscultating for a bruit, with instructions to report the absence of these signs to the dialysis unit and physician. However, the medical record lacked documentation of any monitoring for bruit and thrill, and the Medication Administration Record (MAR) and Treatment Administration Record (TAR) did not include directions or evidence of such monitoring. Interviews with the resident and staff confirmed that nursing staff did not perform or document these assessments. Further, an LPN was unaware of the requirements to check for bruit and thrill and stated that nothing needed to be done with the access site, while the DON confirmed that staff did not check for bruit and thrill on dialysis patients. The facility's own Hemodialysis Access Care policy required staff to check the patency of the site at regular intervals by palpating for thrill or auscultating for bruit, but this was not followed for the resident in question.