Failure to Ensure Appropriate Orders and Monitoring for Dialysis Care
Penalty
Summary
The deficiency involves the facility’s failure to provide dialysis services consistent with professional standards of practice for two residents with end stage renal disease (ESRD). For one resident admitted with ESRD and dependent on dialysis, the medical record showed an admission date of 2/5/26 and a care plan identifying risk for ineffective tissue perfusion and excessive fluid volume, with tasks to ensure attendance at dialysis and monitoring of the fistula, bruit, and thrill. However, the active physician order summary contained no orders for dialysis and no orders directing staff to monitor the dialysis site or assess bruit and thrill before and after treatments. Observation confirmed the presence of a dialysis shunt in the right upper arm, and the resident reported attending dialysis three times weekly and stated that staff did not check the dialysis shunt before or after treatments. A second resident, admitted on 3/4/26 with ESRD, had a care plan noting risk for imbalanced fluids and ineffective tissue perfusion related to ESRD, with tasks to ensure attendance at scheduled dialysis and nursing assessment as ordered. The physician order summary included an order for dialysis three times weekly with a specified chair time but did not include any orders for staff to monitor the dialysis access site or assess bruit and thrill. Observation showed a dialysis shunt in the upper left arm, and the resident reported attending dialysis three times weekly and stated that staff did not always check vital signs or assess bruit and thrill before or after dialysis. An LPN stated that standard practice should include obtaining vital signs, administering medications, and checking bruit and thrill before dialysis, with corresponding physician orders, but was unaware that proper orders were missing. The DON and Administrator acknowledged there was no dialysis policy, that the ADON was responsible for ensuring appropriate orders, and that they were unaware the residents lacked physician orders for dialysis and for monitoring bruit and thrill.
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