F698 — Dialysis Care
Failure to provide proper dialysis services — including hemodialysis access site care, communication with the dialysis center, and management of fluid/dietary restrictions for dialysis residents.
Reg cite · 42 CFR 483.25(l)
64 surveys in corpus
21 states
What surveyors look for
- Dialysis log/binder documenting pre-dialysis weight, blood pressure, access assessment, and post-dialysis comparable data
- Communication with the dialysis center each treatment day with documentation of what was reported and received back
- Daily access (fistula/graft/catheter) assessment for thrill, bruit, infection signs
- Fluid and dietary restrictions clearly communicated to dietary, with sodium/potassium-restricted menus
Common gotchas
- Pre/post-dialysis weights not recorded; large fluid shifts not investigated
- Catheter dressing changes not documented per facility policy
- Resident given excess fluids on non-dialysis days without monitoring
Real survey examples
From CMS-published 2567s in our corpus. Resident identifiers redacted.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide safe, appropriate dialysis care/services for a resident who requires such services.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interviews, resident record review, and review of a facility policy titled, Hemodialysis Care, the facility failed
to ensure Resident Identifier (RI) #9 received care and services related to dialysis when RI #9 missed a
dialysis appointment on [date].
This deficient practice affected RI #9, one of one resident sampled for dialysis care and se…
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
no answer. LPN #17 stated she called the local ambulance company; however, they could not transport RI
#9 due to emergency calls.
A follow-up interview was conducted with LPN #17 on [date] at 12:30 PM. LPN #17 stated she was
unaware of a backup plan for dialysis residents when transportation was not available. LPN #17 admitted
she should have contacted the Medical Director (MD) to inform him of RI #9's missed appointment and
followed any orders given by the MD. LPN #17 stated the potential harm of a resident mis…
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Provide safe, appropriate dialysis care/services for a resident who requires such services.
.
Based on observation, interview and record review, the facility failed to ensure one resident (#41), out of
one resident reviewed for dialysis (the process of cleansing the blood by passing it through a special
machine, necessary when the kidneys are unable to filter the blood), received the services consistent with
professional standards of practice. Specifically, the facility failed to ensure:
1) blood pressure measu…
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
care plan, he answered No.
Hypertension (high blood pressure):
Review of Resident's Care Plan last reviewed [date], revealed: Give anti-hypertensive medications as
ordered.
Review of Resident's medication order, with a start date of [date], revealed, Hydralazine [medication
used to decrease blood pressure] . Give 1 tablet by mouth every 6 hours as needed for Elevated b/p Give
for SBP [systolic blood pressure]>[greater than] 150 or DBP [diastolic blood pressure] > 90 on
NON-DIALYSIS DAYS ONLY.
Review of Re…
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
During an interview on [date] at 11:10 AM, Licensed Nurse (LN)#12 stated, . A pre and post dialysis
assessment should be charted in the electronic chart, when they [residents] go [to dialysis] and when they
come back .
Record review of the facility's Hemodialysis Care policy, revised on 11/2023, revealed, Residents who
require hemodialysis are provided ongoing assessment and monitoring of the resident's condition before
and after dialysis treatments including monitoring for complications and interventions as pa…
Accepted POC examples
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