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494.60 Condition: Physical environment.

Standard: Patient care environment.

Policy/procedure is needed to assure that –

 the dialysis facility maintains a comfortable temperature within the facility; and makes reasonable accommodations for the patients who are not comfortable at this temperature.  This might be allowing patients to bring blankets or providing covering;

 the dialysis facility makes accommodations to provide for patient privacy when patients are examined or treated and body exposure is required. This means providing screens or curtains;

 patients are in view of staff during hemodialysis treatment to ensure patient safety.  Note that video surveillance does not meet this requirement.

494.80 Condition: Patient assessment.

Standard: Frequency of assessment for patients admitted to the dialysis facility.

P&Ps need to reflect that an initial comprehensive assessment shall be conducted on all new patients (that is, all admissions to a dialysis facility), within the latter of 30 calendar days or 13 outpatient hemodialysis sessions beginning with the first outpatient dialysis session. A follow up comprehensive reassessment shall occur within 3 months after the completion of the initial assessment to provide information to adjust the patient’s plan of care.

Standard: Patient reassessment.

P&Ps should include what the facility considers to be definitions of the italicized words (italics added).

A comprehensive reassessment of each patient and a revision of the plan of care shall be conducted—

(1) At least annually for stable patients; and

(2) At least monthly for unstable patients including, but not limited to, patients with the following: (i) Extended or frequent hospitalizations; (ii) Marked deterioration in health status; (iii) Significant change in psychosocial needs; or (iv) Concurrent poor nutritional status, unmanaged anemia, and inadequate dialysis.


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