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 012512 (X3) Date Survey Completed 11/17/2022
Name of Provider or Supplier Fmc Dialysis Services Selma Street Address, City, State 905 Medical Center Parkway, Selma, 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)
V0250 DIALYS PROPORT-MONITOR PH/CONDUCTIVITY
CFR(s): 494.40(a)

5.6 Dialysate proportioning: monitor pH/conductivity It is necessary for the operator to follow the manufacturer's instructions regarding dialysate conductivity and to measure approximate pH with an independent method before starting the treatment of the next patient.


This STANDARD is not met as evidenced by:
Based on observations, review of Myron L Operation Manual, and interviews with facility staff, it was determined the staff failed to follow the facility procedure for testing dialysate conductivity prior to treatment initiation. This affected 1 of 2 observations conducted and had the potential to negatively affect all patients who dialyze at the facility. Findings include: Title: Myron L Operation Manual Digital Dialysate Meter Date: February 16, 2018 ...C. Measuring pH (D-6, type of meter) ...2. Rinse pH (measure of how acidic/basic water is)/ORP (Oxidation Reduction Potential) sensor well and conductivity cell three times with sample to be measured. Shake out each sample to remove any residual liquid. 3. Refill pH/ORP sensor well and conductivity cell with sample. 4. Press pH... An observation was conducted on 11/16/22 at 9:30 AM to observe Employee Identifier (EI) # 5, Registered Nurse, perform conductivity testing with a Myron L D-6 meter in the preparation of a Hemodialysis machine at station 13. EI # 5 filled the sensor well and conductivity cell with dialysate solution one time, attempted to obtain reading, poured sample in the sink, refilled sensor well and conductivity cell and obtained conductivity reading. EI # 5 failed to fill sensor well and conductivity cell three times with sample when obtaining conductivity reading. An interview was conducted with EI # 1, Clinic Manager, on 11/17/22 at 11:30 AM who confirmed the staff failed to follow procedure for checking conductivity.