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 852552 (X3) Date Survey Completed 08/16/2024
Name of Provider or Supplier Fresenius Kidney Care Mcdonough Street Address, City, State 50 Kelly Road, Ste 100, Mcdonough, 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 and staff interview, it was determined that the facility failed to ensure that one of one licensed staff (RNAA) observed, adhered to policy and procedure pertaining to medication preparation and administration. This deficient practice had the potential to negatively affect the health and safety of all 46 in center hemodialysis (ICHD) patients who received dialysis treatment at this facility. Findings include: During observations of the drawer of the medication cabinet located in the Treatment Room on 8/14/24 at approximately 10:40 a.m., surveyor found one 10 milliliter (ml) syringe and one three milliliter syringe filled with a clear colored liquid labeled Heparin (blood thinner). During an interview on 8/14/24 at 10:42 a.m., RN AA acknowledged the findings. No comment was made when asked why the medication was pre-drawn and in the cabinet drawer. A review of the facility's policy titled "Medication Preparation and Administration for Inpatient Services", Published 07/06/21; version 1 showed the following: Pg.3- Only one immediately administered medication may be drawn up and administered at a time. Immediately administered medications were prepared, directly brought to the patient, and administered by the same Fresenius Kidney Care (FKC) nurse without a break in the process.