Failure to Follow Physician's Orders for IV Midline Catheter Care
Penalty
Summary
The facility failed to ensure that physician's orders were followed for the care of an IV Midline Catheter for a resident. The facility's policy on intravenous access required site care and dressing changes at established intervals or immediately if the dressing's integrity was compromised. However, the resident's care plan did not include a plan for the management of the IV midline catheter, and the Medication Administration Record and Treatment Administration Record did not reflect the physician's order for transparent dressing changes. During an observation, the resident was found with a soiled IV catheter site, with dried blood underneath the dressing, and the dressing lacked a date indicating when it was last changed. Interviews with the Unit Director RN and the Director of Nursing confirmed the dressing's soiled condition and the absence of a care plan for the IV midline catheter, indicating a failure to follow the physician's orders for catheter care.
Plan Of Correction
1. R229 midline dressing was changed. Midline was discontinued 2/17/2025. 2. Director of nursing or designee will conduct a house audit of residents with intravenous lines to ensure orders for dressing changes are present and being followed. 3. Director of nursing or designee will in-service licensed staff on ensuring orders for weekly midline and PICC line dressing changes are followed, dressings are dated when done, and care plan interventions are present for care of intravenous lines. 4. Director of nursing or designee will audit 3 residents with midlines or PICC lines weekly for 2 weeks, then 2 residents weekly for 2 weeks, then 2 residents monthly for 2 months to ensure orders for dressing changes are present and being followed, and insertion site dressings are dated and care of lines are reflected in the plan of care. Audit findings will be shared with QAPI committee.