Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 012501 (X3) Date Survey Completed 06/30/2021
Name of Provider or Supplier Gadsden Dialysis Street Address, City, State 409 South First Street, Gadsden, 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 the review of medical records (MR) and interviews, it was determined the facility failed to provide anemia management for 2 of 5 medical records of patients receiving Venofer. This did affect Patient Identifier (PI) # 1, PI # 3, and had the potential to negatively affect all patients served by this facility. Findings include: 1. PI # 1 was admitted to the facility on 5/7/21 with a primary diagnosis of End Stage Renal Disease (ESRD). Review of the hemodialysis orders dated 5/11/21 revealed, "Venofer/Iron Sucrose 50.0 mg (milligrams) IV (Intravenous) qw (every week)". Review of the MR revealed PI # 1 dialyzed on 6/23/21 and 6/25/21. There was no documentation PI # 1 was administered Venofer 50 mg IV the week of 6/21/21 to 6/25/21 as ordered. An interview was conducted on 6/30/21 at 11:40 PM with Employee Identifier (EI) # 1, Facility Administrator, who confirmed PI # 1 did not receive his/her Venofer for anemia management the week of 6/21/21. 42144 2. PI # 3 was admitted to the facility on 4/3/19 with a primary diagnosis of ESRD. Review of the hemodialysis orders dated 10/21/2020 revealed, "Venofer/Iron Sucrose 50.0 mg IV Push qw." Review of the MR revealed PI # 3 dialyzed on 6/23/21 and 6/25/21. There was no documentation PI # 3 was administered Venofer 50 mg IV the week of 6/21/21 to 6/25/21 as ordered. An interview was conducted on 6/30/21 at 11:40 AM with EI # 1, who confirmed PI # 3 did not receive his/her Venofer for anemia management the week of 6/21/21.