Failure to Ensure Physician Orders and Monitoring for Dialysis Access
Penalty
Summary
The facility failed to provide dialysis care and services consistent with professional standards of practice for a resident with end stage renal disease and dependence on renal dialysis. Specifically, the facility did not ensure there was a physician's order in place to assess the resident's dialysis shunt or fistula after it was placed. Additionally, the facility did not monitor the resident's dialysis catheter by assessing for the presence of a thrill and bruit each shift, as required for proper monitoring of dialysis access. Interviews with nursing staff and review of the resident's records confirmed that although staff were aware of the need to assess the dialysis shunt, there was no physician order directing this care, and documentation of assessments was not consistently maintained in the resident's progress notes. The lack of orders and consistent monitoring was acknowledged by both the ADON and DON, who stated that the order should have been initiated when the shunt was placed. The facility's own policy emphasized the necessity of physician orders to ensure residents receive appropriate care and services.