Failure to Provide Standards of Care for Dialysis Services
Penalty
Summary
The facility failed to provide appropriate standards of care for a resident with end-stage renal disease (ESRD) who required dialysis. The resident's electronic medical record (EMR) documented diagnoses of congestive heart failure and ESRD, with a care area assessment indicating the need for dialysis three times a week and additional assistance with activities of daily living. Despite these needs, the resident's care plan and EMR lacked specific directions for staff regarding dialysis care, including the absence of physician orders for dialysis, instructions for accessing the resident's dialysis shunt, and details about the dialysis location, transportation provider, and schedule. Interviews with facility staff revealed that nurses relied on the treatment administration record, nursing report, and care plan for dialysis orders, but these documents did not contain the necessary information. Staff also indicated that dialysis care was managed externally and that there was no clear process for nursing staff to monitor or manage the resident's dialysis needs within the facility. The facility's own dialysis policy required a physician's order and arrangements for dialysis services and transportation, but these were not documented in the resident's records.