Failure to Provide Required Dialysis Assessments and Physician Notification
Penalty
Summary
The facility failed to provide safe and appropriate dialysis care and services for residents requiring such treatment. Specifically, two residents who required dialysis did not have any dialysis care orders in their medical charts, and there was no documentation or evidence that pre- and post-dialysis assessments were performed for these residents. Additionally, the dialysis access sites for these residents were not assessed on each shift as required by facility policy. Interviews with nursing staff and the Director of Nursing confirmed the absence of these orders and assessments, and staff reported that they were only aware of residents' dialysis schedules through a daily sheet, not through formal orders or protocols. Staff also indicated they had not received education specific to dialysis care prior to working at the facility. For another resident, the facility failed to notify the physician when the resident missed a scheduled dialysis treatment. The resident had a diagnosis of dependence on renal dialysis due to end-stage chronic kidney disease and was scheduled for dialysis, but did not attend the appointment. There was no evidence in the medical chart that the provider had been notified of the missed treatment, as required by facility policy. Interviews with staff and the Director of Nursing confirmed that the provider was not notified and that there was no documentation of such notification in the resident's chart. Facility policies reviewed indicated that medical conditions, including those requiring dialysis, should be monitored and managed to prevent complications, with specific requirements for assessment and documentation. However, the lack of dialysis care orders, failure to perform required assessments, and failure to notify the physician of a missed dialysis session demonstrate noncompliance with these policies and regulatory requirements.