Failure to Rotate Subcutaneous Injection Sites for Anticoagulant Administration
Penalty
Summary
The facility failed to ensure that subcutaneous injection sites were rotated for a resident receiving anticoagulant therapy, specifically Enoxaparin Sodium (Lovenox), as required by professional standards of practice. Review of the resident's Medication Administration Record (MAR) for March and April showed that injections were consistently documented as being administered in the abdomen, without specifying the exact area or indicating rotation of sites. This practice was confirmed during an interview with a registered nurse, who acknowledged that proper documentation and rotation of injection sites are necessary to prevent tissue damage and discomfort. The resident involved had a history of muscle weakness, COPD, and hypertension, and required staff assistance with activities of daily living. The resident's cognitive skills for daily decision-making were intact. Physician orders directed daily subcutaneous administration of Lovenox for deep vein thrombosis prophylaxis. Manufacturer instructions provided by the facility also specified alternating injection sites between the left and right sides of the abdomen. Despite these guidelines, the facility's documentation and practice did not reflect adherence to site rotation protocols.