Failure to Ensure Nursing Staff Competency in Dialysis Care and Assessment
Penalty
Summary
The facility failed to ensure that nurses and nurse aides possessed the necessary competencies to provide appropriate care for residents requiring dialysis. Specifically, two of five sampled staff, including a registered nurse and a licensed vocational nurse, did not receive orientation or in-service training on dialysis care, assessment, or site evaluation. Review of their annual skills checklists and job descriptions revealed no documentation of dialysis-related competencies, and interviews with staff confirmed that dialysis care and assessment were not included in their orientation or ongoing training. The Director of Staff Development acknowledged that dialysis care, assessment, and training were not part of the orientation process and had not been provided to nursing staff, including CNAs, until recently. Staff interviews further revealed a lack of instruction on how to assess dialysis sites for thrill and bruit, as well as on procedures for managing residents before and after dialysis treatments. Some staff demonstrated confusion regarding the correct methods for assessing dialysis access sites, indicating gaps in knowledge and skills necessary for safe resident care. The Director of Nursing confirmed that while an in-service on dialysis care was provided in the past year, there was no formal class or consistent inclusion of dialysis care and assessment in new staff orientation. The facility's policy required nursing staff to demonstrate competencies based on resident needs, but this policy was not followed regarding dialysis care. The lack of documented training and competency checks for dialysis care and assessment had the potential to impact the safe provision of nursing care for residents undergoing dialysis.