Deficient Dialysis Communication, Orders, and Care Planning
Penalty
Summary
The facility failed to provide consistent and complete communication with the dialysis center for two of three residents reviewed, as evidenced by numerous incomplete or missing dialysis communication records. Specifically, one resident with end stage kidney disease, diabetes, and anxiety had over twenty days of missing or incomplete communication records with the dialysis center, while another resident had fourteen days of incomplete or missing records. Staff interviews, including those with an LPN, RN, and the Director of Nursing, confirmed these lapses in communication documentation. Additionally, the facility did not have physician orders for the care and management of dialysis access devices for two residents. One resident with a right upper arm fistula and another with a tessio catheter did not have corresponding physician orders for access site care. Furthermore, care plans for these residents were incomplete, failing to specify the type and location of the access device or omitting care and management instructions altogether. These deficiencies were confirmed by the Director of Nursing and were not in accordance with the facility's own policy or regulatory requirements.