Failure to Monitor and Document Dialysis Access Site Care
Penalty
Summary
The facility failed to consistently monitor and document the care of a resident receiving hemodialysis through a left arm arteriovenous (AV) fistula. According to the facility's policy, licensed nurses are required to maintain the patency of the access area, monitor for signs of infection or complications, and check for bruit and thrill every shift, documenting these assessments in the resident's electronic health record. The care plan for the resident also specified the need to assess for bruit and thrill and monitor for symptoms such as pain, numbness, redness, swelling, warmth, exudate, and tenderness at the fistula site. However, a review of the resident's clinical and treatment administration records revealed no documented evidence that these required assessments were being performed consistently. Additionally, there was no physician order in place for staff to check bruit and thrill or to assess the AV fistula site. This was confirmed by the Infection Control Nurse, who stated that staff were expected to complete and document these checks every shift, but this was not being done for the resident in question.