Improper Documentation and Administration of TPN by LPNs
Penalty
Summary
The facility failed to ensure that the administration of total parenteral nutrition (TPN) was completed in accordance with professional standards of practice, specifically regarding the roles and responsibilities of nursing staff. Medical record reviews for two residents with complex medical histories, including surgical aftercare, intestinal fistulas, colostomy status, protein-calorie malnutrition, and lymphoma, revealed that TPN was ordered and administered over several months. Both residents had care plans and physician orders specifying TPN administration, with instructions for registered nurses (RNs) to mix and manage the TPN solutions. However, review of the Medication Administration Records (MAR) showed that licensed practical nurses (LPNs) repeatedly signed off on the administration of TPN for both residents. Interviews with the Director of Nursing (DON) and LPNs confirmed that LPNs did not actually administer the TPN but signed the MAR as if they had, sometimes indicating that they were signing off for the RNs. The DON and LPNs acknowledged that LPNs are not permitted to initiate or maintain TPN, as it is outside their scope of practice according to the Ohio Revised Code. Facility policy review confirmed that only licensed nursing staff authorized by state law should prepare, administer, and record medications, and that LPNs are specifically prohibited from initiating or maintaining TPN. The deficiency was identified through a combination of medical record review, staff interviews, and policy review, and it affected two of three residents reviewed for IV administration.