CENTER, MO - Federal inspectors identified significant gaps in dialysis patient care protocols at Westview Nursing Home during a May 2025 inspection, finding nursing staff lacked awareness of essential monitoring procedures for residents receiving life-sustaining kidney treatments.
Staff Knowledge Gaps Documented
Licensed Practical Nurse B told inspectors during a May 21 interview that they were "unaware of any specific protocols to follow when a resident returned from dialysis." This admission highlighted a concerning knowledge deficit regarding care for one of the facility's most medically vulnerable patient populations.
The inspection focused on protocols for Resident #1, who received regular dialysis treatments through an arteriovenous fistula - a surgically created connection between an artery and vein that provides vascular access for the treatment. Dialysis patients require specialized monitoring due to the complex medical risks associated with both the treatment and the access site.
Inconsistent Management Directives
The facility's leadership provided conflicting information about monitoring expectations during the inspection. The Assistant Director of Nursing stated during a May 20 interview that staff were required to obtain weights and vital signs on dialysis days and assess for bleeding at the fistula site. However, this administrator said nursing staff were not expected to check for bruit or thrill - critical indicators of fistula function.
Three weeks later, the Director of Nursing contradicted this guidance, telling inspectors that staff should follow facility policies requiring monitoring for bleeding, thrill, bruit, and signs of infection at the access site.
Medical Significance of Proper Monitoring
Post-dialysis monitoring serves multiple critical functions in patient safety. Weight measurements help detect fluid retention that could indicate treatment inadequacy or cardiovascular complications. Vital sign assessment identifies potential hypotension from fluid removal or hypertension from incomplete treatment.
Fistula assessment requires specific expertise. A thrill - the vibration felt over the access site - indicates adequate blood flow through the connection. Bruit, an audible sound detected with a stethoscope, provides additional confirmation of proper function. Absence of either finding can signal thrombosis or stenosis requiring immediate medical intervention.
Bleeding assessment prevents hemorrhagic complications, while infection monitoring helps identify access site complications that could lead to sepsis. These assessments must occur promptly after dialysis when complications are most likely to manifest.
Industry Standards for Dialysis Care
Professional nursing standards require comprehensive post-dialysis assessment within specific timeframes. The National Kidney Foundation guidelines emphasize that dialysis access sites need immediate evaluation for function and complications after each treatment session.
Proper protocols should include systematic assessment of access site appearance, palpation for thrill, auscultation for bruit, and documentation of findings. Staff should understand normal versus abnormal findings and know when to notify physicians of concerning changes.
Regulatory Requirements
Federal regulations require nursing facilities to ensure staff competency for specialized care procedures. When facilities accept residents requiring dialysis, they must demonstrate adequate staffing knowledge and established protocols for safe care delivery.
The inconsistent guidance between nursing leadership suggests systemic issues with policy implementation and staff education. Effective dialysis care requires clear, consistent protocols understood by all nursing personnel involved in patient care.
Facility Response and Corrections
Federal surveyors classified this violation as minimal harm with potential for actual harm, affecting few residents. However, the knowledge gaps identified could have serious consequences for patients dependent on dialysis treatments.
Proper corrective measures should include comprehensive staff education on dialysis patient care, clear written protocols for post-treatment assessment, and regular competency validation for nursing personnel. Leadership must provide consistent guidance and ensure all staff understand their monitoring responsibilities.
The facility was required to submit a plan of correction addressing the identified deficiencies. Families of residents receiving dialysis treatments may wish to review the complete inspection report and discuss care protocols with facility administration to ensure proper monitoring procedures are implemented.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Westview Nursing Home from 2025-05-21 including all violations, facility responses, and corrective action plans.
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