Failure to Ensure Effective Communication with Dialysis Center
Penalty
Summary
The facility failed to ensure effective communication and documentation between its staff and the dialysis center for a resident who required regular dialysis treatments. Medical record review showed that the resident, who had end-stage renal disease, heart failure, type II diabetes mellitus, hypertension, and was dependent on renal dialysis, was admitted to the facility and had physician orders for dialysis three times a week. The resident was cognitively intact and assessed to receive dialysis. However, review of the dialysis communication forms over a two-month period revealed that, on multiple occasions, the section of the form to be completed by the dialysis center was left blank. Further review of both electronic and paper medical records indicated there was no evidence that the facility staff contacted the dialysis center to have the forms completed or to inquire about the resident's status during dialysis on those dates. An interview with the DON confirmed that the dialysis center had not completed their portion of the communication forms and that there was no documentation of attempts by facility staff to communicate with the dialysis center. The facility's contract with the dialysis provider required documented evidence of collaboration and communication, which was not present in these instances.