Failure to Maintain Physician Order for Dialysis Services
Penalty
Summary
The deficiency involves the facility’s failure to obtain and maintain a physician’s order for dialysis for a resident with end-stage renal disease who required ongoing dialysis treatments. The resident had been hospitalized for shortness of breath and progressive renal failure, had a permacath placed, and began dialysis in the hospital with a scheduled outpatient regimen on Tuesday, Thursday, and Saturday. Upon readmission to the facility with a diagnosis that included end-stage renal disease requiring dialysis, the physician’s orders did not include dialysis services, even though the resident continued to receive dialysis treatments. The resident’s care plan, updated shortly after readmission, documented the need for dialysis related to renal failure and included interventions such as checking and changing the dressing at the access site daily, monitoring the access site for signs of infection, and encouraging the resident to attend scheduled dialysis appointments three times a week. However, the quarterly MDS assessment did not code the resident as receiving dialysis services despite documenting end-stage renal disease. During interviews, a nurse confirmed the resident was at dialysis on the survey day, and the DON acknowledged being unaware that the dialysis order was missing and that staff likely failed to enter the order upon readmission. The Administrator also stated that the dialysis order should have been entered into the computer system when the resident returned from the hospital.
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