F698 Dialysis: Nursing Home Quality Assurance for ESRD Residents on Dialysis

F698 Dialysis: Nursing Home Quality Assurance for ESRD Residents on Dialysis

 

How effectively is your facility monitoring dialysis services to ensure regulatory compliance? Consider these guidelines as part of your Quality Assurance (QA) process…

 

Appendix PP of the State Operations Manua (SOM)l includes F698 which defines the requirements for facilities caring for residents receiving dialysis services.  The SOM states: “The facility must ensure that residents who require dialysis receive such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents’ goals and preferences.” How can the facility monitor dialysis services to ensure they are meeting the stipulations of this regulation?

 

One of the best means for the monitoring of any system in the facility, including dialysis services, is by following the CMS Critical Element Pathways (CEPs) that are utilized by the Surveyors themselves. CEP #20071 outlines key areas to monitor for Dialysis Services. This tool serves as a guide to review the essential elements that must be addressed for residents receiving dialysis care.

 

Critical areas for review include the following:

 

Observations:

• Are appropriate infection control practices being utilized when caring for dialysis devices and access sites including hand hygiene and use of PPE?
• Are dialysis access site dressings clean, dry and intact and being changed as ordered?
• Are care planned and ordered interventions being implemented consistently?
• Are food/fluid restrictions being implemented/followed?

 

Record Review:

• Are individualized risk factors and potential complications related to dialysis (e.g., bleeding, infection, skin integrity, and the effects of dialysis on medication therapy) addressed on the care plan and in the progress notes?
• Does the care plan address the necessary emergency interventions to implement should an event occur related to the shunt or shunt site such as dislodgement or hemorrhaging?
• Are resident choices/preferences addressed on the care plan and being honored such as advance directives?
• Is there evidence the resident’s underlying health conditions/comorbidities and dialysis site are being monitored adequately with changes reported to the health care practitioner and resident representative as indicated?
• Is there documented evidence of cooperation, collaboration and communication between the facility and the dialysis provider?
• Is there evidence of consideration of resident needs while at dialysis, such as providing a meal/snack, provision of a pressure relieving device, and coordination of labs and medications?

 

Resident/Representative Interview:

• How were you involved in the development of the care plan and goals specific to dialysis? Do the interventions reflect your choices and preferences?
• Do you have any concerns with your dialysis treatment? Do you know who to discuss the concerns with? Were your concerns addressed? If not, why not?
• Are you on fluid or food restrictions? If so, how does staff monitor your intake? Do you follow your restricted diet and fluids? If not, has staff provided education about the risks and tried to provide alternatives?
• How often do you receive treatments? Have treatments been cancelled or missed? If so, why? Were they rescheduled and by whom?

 

Staff Interview:

• What type of staff training for dialysis care and services did you receive and who provided the training?
• What type of dialysis is the resident receiving? How do you care for the access sites and dressing changes?
• When do you monitor vital signs and weights? Are there any restrictions for food or fluids and how is it tracked?
• What do you do if the resident declines a dialysis treatment, is ill, or if treatments are cancelled?
• Has the resident had any dialysis-related complications (e.g., dizziness, falls, bleeding)? To whom do you report possible complications or changes in condition?
• How is care coordinated and communicated between dialysis staff and the facility, including documentation of the resident’s status, nutrition, adequate hydration, psychosocial and nursing needs, current dialysis treatment, and the possible need to modify the current interventions?

 

Through auditing and monitoring activities guided by the CMS Critical Element Pathway as part of the facility QAPI program, the facility can systematically review compliance with key elements of F698 including ESRD and dialysis care systems and processes.  The frequency of audits may be driven by past compliance, but is recommended a minimum of every 4 – 6 months (depending on the census for residents with dialysis) to routinely monitor compliance.  If concerns are identified, a targeted action plan should be developed and implemented with the audit cycle repeated to verify effectiveness of the implemented plan.

 

Next steps:

Contact Proactive for nursing home consulting services including QAPI support, LTC training and to schedule a mock survey.  Access the CMS 20071 dialysis critical element pathway

 

 

 

 

Written By:

 

Janine Lehman, RN, RAC-CT, CLNC

Director of Clinical Services

Proactive LTC Consulting