A resident with ESRD and dialysis dependence had a right IJ central catheter, and the care plan and MD order required a clamp, gauze, and tape to be kept at the bedside every shift. Surveyors observed that the required emergency supplies were not at the bedside, and a UM searched the room but could not locate them.
A resident receiving dialysis had no physician order identifying the access site or directing access monitoring, and the chart lacked documentation of bruit and thrill assessments. Staff also reported there was no dialysis communication book and no communication with the dialysis center regarding labs, weights, or vital signs.
A resident with ESRD and dependence on renal dialysis had blank dialysis communication forms and no evidence of completed facility-to-dialysis center communication for multiple dialysis days. The resident’s dialysis binder also lacked current physician orders, and staff interviews confirmed that the form was supposed to include vital signs, medications, and other key information before the resident went to dialysis, but this was not being done.
A resident with ESRD and a right tunneled femoral hemodialysis line did not have the ordered bedside clamp available. Surveyors observed a gauze bag above the bed but no clamp, and the UM and DON confirmed the clamp should have been kept at the bedside per the MD order for emergency use if the line broke.
Failure to Address Dialysis Medication Recommendation: A resident with ESRD and severe cognitive impairment returned from dialysis with a recommendation for sevemar carbonate to be given with meals for phosphate control, but the medical record did not show that the physician was contacted to approve or deny the recommendation. The Unit Mgr and DONs stated the dialysis communication book should be reviewed after dialysis and the physician contacted promptly, within 24 hours.
A resident receiving dialysis was prescribed calcium acetate as a phosphorus binder to be given with meals and snacks, but the medication was scheduled at times that did not match mealtimes. Nursing staff, the unit manager, the DON, and the physician all confirmed the binder should have been administered during meals, while dialysis records showed the resident’s phosphorus remained elevated.
A resident with ESRD and multiple dialysis access sites did not receive care consistent with orders and dialysis standards. Nursing staff documented blood pressures in both arms despite AV fistulas and a dialysis catheter, failed to notify the provider or obtain an order when the catheter dressing was missing and sutures were loosened, and did not give the phosphorus binder with meals even though the resident ate breakfast before early dialysis transport.
A resident with ESRD and a RUE AV fistula had repeated BPs taken in the fistula arm despite a no-BP order and care plan instructions. After the fistula became clotted and the resident returned from the hospital with a tunneled chest HD catheter, the facility did not have physician orders in place for catheter care and maintenance for several days.
A resident receiving weekday hemodialysis with a CVC had a physician order for a non-toothed clamp at the bedside at all times when the catheter was in use, but surveyors did not find the clamp or any other emergency supplies in the room. The resident was cognitively intact and unsure what the clamp was, while the UM and DON stated the clamp and emergency supplies should have been available at the bedside/headboard.
A resident with ESRD, heart failure, and BPH had a M/W/F dialysis schedule, but nursing did not ensure ordered cardiac meds were timed around dialysis. The MAR showed repeated omissions of metoprolol ER and isosorbide mononitrate ER, documented as out of facility on dialysis days, while the resident reported BP drops during dialysis and the NP and DON stated the meds should be administered around the dialysis schedule.
Self-audit
Pick a level of detail and, optionally, what to focus on — then generate a survey-ready checklist distilled from the most recent citations.
Beta · AI-generated — for reference only, not professional advice. Verify against current CMS guidance before relying on it. Assisto accepts no responsibility for how this checklist is used.
Citations used to create this checklist
Trusted data from CMS and state health departments
Every citation, penalty and Plan of Correction is sourced from public CMS records (latest release July 29, 2026) and official state health department websites — never guesswork.
In your survey window? See what surveyors are citing.
The Survey-Prep Report maps your facility's risk from 12 months of CMS and state citation data — what's being cited around you and what to check first. $129 one-time.