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 852542 (X3) Date Survey Completed 05/18/2021
Name of Provider or Supplier Red Hills Dialysis Street Address, City, State 201 Old Albany Road, Thomasville, GA
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)
V0143 IC-ASEPTIC TECHNIQUES FOR IV MEDS
CFR(s): 494.30(b)(2)

[The facility must-] (2) Ensure that clinical staff demonstrate compliance with current aseptic techniques when dispensing and administering intravenous medications from vials and ampules; and


This STANDARD is not met as evidenced by:
Based on observation, interview, and policy review, the facility failed to ensure an open vial of medication was dated and labeled as required for one of two survey days. The failure to date and label the medication vial had the potential for staff to use a medication that was expired and could affect 85 in-center patients. Findings include: Observation on 05/18/21 at 9:50 AM revealed an open vial of Purified Protein Derivative (PPD) (medication used to test patient for Tuberculosis), that was unlabeled in the medication refrigerator. During an interview with Registered Nurse (RN) 8 on 05/18/21 at 9:55 AM, he/she stated the medication should have been labeled with date of opening and initials of person opening. RN8 stated the medication was only good for 30 days after opening and that could not be determined if it was unlabeled. Review of the facility's policy titled, "Intradermal Tuberculin Skin Test (TST)- Purified Protein Derivative (PPD) Mantoux Test," revised April 2021, revealed the following, "Tubersol manufacturer product insert states "A vial of Tuberculin (PPD) which has been entered and in use for 30 days should be discarded because oxidation and degradation may have reduced the potency."