Failure to Ensure Consistent Dialysis Communication and Comprehensive Care Planning
Penalty
Summary
The facility failed to provide consistent and complete communication with the dialysis center for a resident with End-Stage Renal Disease (ESRD) who required regular hemodialysis treatments. Review of the clinical record showed that communication forms between the facility and the dialysis provider were missing or incomplete for several dates within a specified period. Additionally, a physician order for dialysis did not include essential information such as the dialysis center's name, address, phone number, or the resident's scheduled chair time. These omissions were contrary to the facility's own policy, which required communication before and after each dialysis treatment. Further review revealed that the resident's care plan, while noting that the resident received dialysis, did not include specific details such as the scheduled dialysis days or the dialysis facility information. The lack of a comprehensive, person-centered care plan and incomplete communication documentation were confirmed during an interview with the Director of Nursing. The resident involved had diagnoses of high blood pressure, ESRD, and muscle weakness at the time of the deficiency.