|Survey Date: 5/24/2010|
Regulation Title: H-IDT OVERSEES HOME TRAINING
Regulation Description: The interdisciplinary team must oversee training of the home dialysis patient, the designated caregiver, or self-dialysis patient before the initiation of home dialysis or self-dialysis (as defined in §494.10) and when the home dialysis caregiver or home dialysis modality changes.
Based on staff interviews and review of facility documents, it was determined that the facility failed to adequately document the training provided to another facility's staff that would be performing peritoneal dialysis on one of the facility's patients.
The findings were:
On 5/21/10 at approximately 8:40 a.m. an interview was conducted with staff that performed home training. The staff agreed that documentation of the other facility's staff by the home training nurse could be improved upon and was not sufficient. The staff member stated that the lack of documentation was recently noted by the facility in an internal audit and was being improved upon currently.
The medical record of a patient that had received home peritoneal dialysis in a long-term care facility (Sample Patient #2) was reviewed on 5/20/10. A nursing progress note was reviewed that was dated 3/24/10. It states, "Trained staff at [facility name] on Baxter cycler. To start CCPD tonight." The note was the only record of training completed with personnel that would be performing peritoneal dialysis on this patient.
Facility Plan of Correction:
The importance of the need to adequately document training provided to the staff of other facilities, such as long-term care facilities, that would be performing peritoneal dialysis on the patient has been reviewed with the home dialysis teammates.
A training tool has been developed to document the content of training provided by the dialysis home nurse to the Long Term Care Facility. This tool will be implemented by 6/30/10 and include, but not be limited to, a signed learning contract, a post test, and a DVD on such training. Part of the training tool that has been developed to train the Long Term Care staff includes a comprehensive overview including sign and symptoms frequently seen with PD patients. Will also ensure the Long Term Care staff has the 24 hour on call PD nurse information available to answer any questions the Long Term Care staff may have. FA/designee will audit record of such patients post training to ensure compliance. Results of audits will be reported in QIFMM and addressed as necessary. FA is responsible for ongoing compliance with POC.