A resident with ESRD, dialysis dependence, and type 2 DM had ordered HD on M/W/F at 7:15 AM, plus insulin lispro, sevelamer, and timolol. The care plan did not address coordinating meds with dialysis, and MAR review showed multiple doses documented as not administered during dialysis times. Staff stated dialysis residents’ meds should be scheduled before or after dialysis, and the DON said the meds should be sequenced to when the resident was in the facility with MD approval.
A resident with ESRD and multiple comorbidities repeatedly missed scheduled medications, supplements, and blood glucose monitoring because administration times conflicted with dialysis appointments. Nursing staff documented missed doses due to the resident being out for dialysis, but there was no evidence that the physician was notified or that orders were adjusted to accommodate the dialysis schedule, contrary to facility policy and professional standards.
A facility failed to adjust medication administration times for a resident undergoing dialysis, leading to missed or delayed doses of diabetes medication. The resident, with end-stage renal disease and diabetes, had scheduled dialysis sessions that conflicted with the prescribed medication time. The facility's policy required coordination with the dialysis center, but this was not effectively implemented, resulting in a deficiency.
A resident receiving dialysis three times a week did not receive adequate care, as the facility failed to document vital signs before dialysis and did not provide meals or snacks before early morning sessions. The dialysis communication forms were inconsistently filled out, and staff interviews revealed confusion about responsibilities. The facility's policy for coordinating with the dietary department and maintaining communication with the dialysis center was not effectively implemented.
The facility failed to adjust medication schedules for two residents requiring dialysis, leading to missed doses and duplicate orders. One resident had duplicate blood sugar check orders, while another had eye drops scheduled during dialysis sessions. The facility's Hemodialysis Policy was not followed, resulting in deficiencies in care.
The facility failed to consistently complete post-dialysis assessments for two residents requiring dialysis services. One resident, with severely impaired cognition, had missing documentation of post-dialysis assessments on several dates, despite a physician's order for monitoring. Another resident, with moderately impaired cognition, also had inconsistent post-dialysis documentation. The facility's policy required post-dialysis observations, but this was not consistently followed.
A facility failed to ensure consistent communication with a contracted dialysis facility for a resident requiring dialysis services. The resident, who had been receiving dialysis for five years, had missing entries for vital signs and other pertinent information on several dates. The LPN confirmed that the communication forms should be completed by the nursing staff before dialysis, but this was not consistently done. Interviews with the DON and LNHA revealed that the facility's process involved using a communication book, but the policy was not consistently followed.
A facility failed to provide appropriate dialysis care for a resident, as the Hemodialysis Communication Record (HCR) was not signed by a nurse for 14 days, and vital signs and dialysis site assessments were not documented. A medication change recommendation was not followed, and the resident's Physician Order Form lacked a diet order. Staff acknowledged these deficiencies, which were contrary to the facility's policy.
A facility failed to adjust medication administration times for a resident undergoing dialysis, resulting in missed doses. The resident, who required dialysis due to end-stage renal disease, was scheduled for treatment on specific days, but the facility did not reschedule medications to accommodate this. The MAR showed missed doses without physician notification or rescheduling, confirmed by interviews with staff. The facility's policy required medication adjustments for dialysis, which was not followed.
A resident with end-stage renal disease did not receive their noon dose of Midodrine on dialysis days due to the facility's failure to adjust medication times. The resident experienced low blood pressure and dizziness during dialysis. Staff interviews revealed a lack of communication and coordination, and the facility's policies prohibited sending medications with residents to dialysis.
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