Failure to Include Dialysis Services in Comprehensive Care Plans
Penalty
Summary
The deficiency involves the facility’s failure to develop comprehensive care plans that included dialysis services, goals/outcomes, and interventions for two residents who were dependent on renal dialysis. For one resident, provider orders documented scheduled dialysis at an outside dialysis center three times weekly with transportation by an outside company, and the MDS identified dependence on renal dialysis and current dialysis treatment. However, the resident’s care plan did not include any information about dialysis services, goals, outcomes, or interventions, and progress notes did not specify the type of dialysis access. For the second resident, provider orders also documented thrice-weekly dialysis at an outside center with transportation by an outside company, and the MDS listed chronic kidney disease stage 3B and dependence on renal dialysis, but the care plan similarly lacked dialysis services, goals/outcomes, and interventions, and progress notes did not indicate the type of dialysis access. During interviews, multiple RNs, including those responsible for creating and revising care plans, stated that information about dialysis—such as the outside dialysis center, treatment schedule, transportation arrangements, and type of dialysis access—should be included in the resident’s care plan when a resident receives dialysis. One RN stated that staff would look to the care plan to determine where a resident receives dialysis, how the resident gets to and from the dialysis center, and what type of dialysis access the resident has, and that the purpose of the care plan is to inform staff that the resident is on dialysis and where the resident goes for treatment. Other RNs acknowledged they did not recall what type of dialysis the residents received or how they traveled to the dialysis center and indicated they would check the care plans for this information, which was not present. The facility’s care plan policy stated that the care plan would emphasize appropriate care and services and address the relationship of items or services required and facility responsibility for providing those services, but this was not carried out for the two residents receiving dialysis.
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