| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 012505 | (X3) Date Survey Completed 09/06/2018 |
| Name of Provider or Supplier Physicians Choice Dialysis-Montgomery | Street Address, City, State 1001 Forest Avenue, Montgomery, AL | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies
(Each deficiency should be preceded by full regulatory or LSC identifying information) |
| V0547 | POC-MANAGE ANEMIA/H/H MEASURED Q MO CFR(s): 494.90(a)(4) The interdisciplinary team must provide the necessary care and services to achieve and sustain the clinically appropriate hemoglobin/hematocrit level. The patient's hemoglobin/hematocrit must be measured at least monthly. The dialysis facility must conduct an evaluation of the patient's anemia management needs. This STANDARD is not met as evidenced by: Based on review of medical records and staff interview, it was determined the facility failed to ensure Epogen administration was documented in the medical record. This affected 1 of 1 peritoneal dialysis (PD) records reviewed and did affect PI (Patient Identifier) # 6 and had the potential to affect all home treatment patients. Findings include: 1. PI # 6 was admitted to PD services on 5/13/09 with diagnoses including End Stage Renal; Disease (ESRD). Record review revealed one clinic visit was made in August on 8/6/18 and monthly lab was obtained. Review of the lab results dated 8/6/18 revealed the hemoglobin was 9.8 grams (LOW), decreased from 10.9 (LOW) on 7/16/18. Review of the Order Inquiry Report documentation revealed a physician order dated 8/8/18 for Epogen 18000 units (u) subcutaneous (sq) every second and fourth week for anemia in ESRD. Review of the August patient scheduling calendar revealed a home visit was completed on 8/13/18. Record review revealed the Home Visit documentation which contained the following:"...Date of Home Visit: 8/13/18, Type of Home Visit: Follow up. Findings or concerns: Home Visit done today. No problems noted with it. See." Further record review of the 8/13/18 PD Home Environment Evaluation Form contained no documentation the nurse or patient administered Epogen 18000 u sq during the 8/13/18 home visit. In an interview on 9/6/18 at 2:20 PM, Employee Identifier # 2 Home Program Manager reported the nurse must administered the Epogen during the home visit. EI # 2 presented the surveyor with a computer generated document, titled Epogen Utilization August 2018. There was no staff name on the document, no site of Epogen administration and no documentation of how the patient tolerated the Epogen injection. Kimberly Coan Hancock, RN, BSN |