Lack of Coordination and Policy for Dialysis Care
Penalty
Summary
The facility failed to ensure proper coordination of care for a resident requiring hemodialysis, as evidenced by the absence of a written contract or agreement with the dialysis provider, lack of a facility dialysis policy, and incomplete documentation of dialysis care. The resident, who had end stage renal disease and was dependent on renal dialysis, did not have a physician's order for hemodialysis documented in the clinical record. Additionally, the Dialysis and Nursing Home Handoff Communication Tool forms were found to be incomplete on multiple occasions, with missing documentation from the dialysis center. Interviews with facility staff, including an LPN, the DON, and the CEO, revealed uncertainty regarding staff responsibilities for dialysis care, monitoring of the fistula site, and review of communication forms from the dialysis center. The DON confirmed the absence of a contract with the dialysis center and a facility dialysis policy, while the CEO expressed uncertainty about what was expected of nursing staff in caring for residents on dialysis and acknowledged that staff may not be reviewing the handoff communication forms. These actions and inactions resulted in uncoordinated and unmonitored care for the resident receiving dialysis.